Robotic-Assisted Laparoscopic Radical Prostatectomy From a Single Chinese Center: a Learning Curve Analysis

OBJECTIVE - To investigate the learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP), and analyze whether surgeon's prior surgical experience has effects on the surgery.

METHODS - From April 2012 to August 2015, 355 consecutive patients with prostate cancer received RALP by three surgeons.

Among these cases, 184 were by surgeon A with prior open experiences, 92 by surgeon B with both open and laparoscopic experiences, and 79 by surgeon C with laparoscopic experiences only. Perioperative, oncological and functional outcomes were evaluated and compared between surgeons. Learning curve patterns were evaluated to determine the number of cases to reach plateau.

RESULTS - Marked difference was observed in operative time among the three groups (all p<0.05). Length of hospital stay was also statistically significant (all p<0.001), except for that between Group B and Group C (p=0.739). Continence at 1-year and 6-month postoperatively was better in Group B and C compared with Group A (p<0.001). Intraoperative blood loss, pathologic stage, positive surgical margin (PSM), biochemical recurrence-free rate and other pathological findings showed no statistical significance between the groups. The number of cases required to reach plateau may vary for surgeons with different surgical experiences.

CONCLUSIONS - Different early surgical background may affect the perioperative parameters of novice RALP surgeons. Previous laparoscopic experiences may provide additional advantage in learning curve parameters compared with surgeons with open experiences only. A better overall continence for laparoscopic surgeons requires further validation.

Urology. 2016 Apr 01 [Epub ahead of print]

Yifan Chang, Min Qu, Linhui Wang, Bo Yang, Rui Chen, Feng Zhu, Haifeng Wang, Yan Wang, Xin Lu, Chunfei Ma, Zhenkai Shi, Zhenyang Dong, Huan Chen, Chuanliang Xu, Yinghao Sun, Xu Gao

Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China.  Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200438, China.