Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon’s experience

Authors

  • Abdullah M Alenizi Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Roger Valdivieso Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Emad Rajih Division of Robotic Urology, Hôpital Sacré Cœur de Montréal
  • Malek Meskawi Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Cristian Toarta Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Marc Bienz Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Mounsif Azizi Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Pierre Alain Hueber Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Hugo Lavigueur-Blouin Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Vincent Trudeau Division of Urology, Centre Hospitalier de l’Université de Montréal
  • Quoc-Dien Trinh Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School
  • Assaad El-Hakim Division of Robotic Urology, Hôpital Sacré Cœur de Montréal
  • Kevin C Zorn Division of Urology, Centre Hospitalier de l’Université de Montréal

DOI:

https://doi.org/10.5489/cuaj.2805

Keywords:

Predictors, operative time, individual steps, robotic-assisted radical prostatectomy, prostate cancer

Abstract

Introduction: We evaluated the average time required to complete individual steps of robotic-assisted radical prostatectomy (RARP) by an expert RARP surgeon. The intent is to help establish a timebased benchmark to aim for during apprenticeship. In addition, we aimed to evaluate preoperative patient factors, which could prolong the operative time of these individual steps.

Methods: We retrospectively identified 247 patients who underwent RARP, performed by an experienced robotic surgeon at our institution. Baseline patient characteristics and the duration of each step were recorded. Multivariate analysis was performed to predict factors of prolonged individual steps.

Results: In multivariable analysis, obesity was a significant predictor of prolonged operative time of: docking (odds ratio [OR] 1.96), urethral division (OR 3.13), and vesico-urethral anastomosis (VUA) (OR 2.63). Prostate volume was also a significant predictor of longer operative time in dorsal vein complex ligation (OR 1.02), bladder neck division (OR 1.03), pedicle control (OR 1.04), urethral division (OR 1.02), and VUA (OR 1.03). A prolonged bladder neck division was predicted by the presence of a median lobe (OR 5.03). Only obesity (OR 2.56) and prostate volume (OR 1.04) were predictors of a longer overall operative time.

Conclusions: Obesity and prostate volume are powerful predictors of longer overall operative time. Furthermore, both can predict prolonged time of several individual RARP steps. The presence of a median lobe is a strong predictor of a longer bladder neck division. These factors should be taken into consideration during RARP training.

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Published

2015-07-17

How to Cite

Alenizi, A. M., Valdivieso, R., Rajih, E., Meskawi, M., Toarta, C., Bienz, M., Azizi, M., Hueber, P. A., Lavigueur-Blouin, H., Trudeau, V., Trinh, Q.-D., El-Hakim, A., & Zorn, K. C. (2015). Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon’s experience. Canadian Urological Association Journal, 9(7-8), E417–22. https://doi.org/10.5489/cuaj.2805

Issue

Section

Original Research