Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons

  • Allen Chang Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Armen Derboghossians Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Jennifer Kaswick Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Brian Kim Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Howard Jung Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Jeff Slezak Department of Research and Evaluation, Kaiser Permanente Southern California
  • Melanie Wuerstle Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Stephen G. Williams Department of Urology, Kaiser Permanente Los Angeles Medical Center
  • Gary W. Chien Department of Urology, Kaiser Permanente Los Angeles Medical Center
Keywords: robotic, prostatectomy, learning curve, proficiency, credentialing

Abstract

Background: Initiating a robotics program is complex, in regards to achieving favourable outcomes, effectively utilizing an expensive surgical tool, and granting console privileges to surgeons. We report the implementation of a community-based robotics program among minimally-invasive surgery (MIS) urologists with and without formal robotics training.

Methods: From August 2008 to December 2010 at Kaiser Permanente Southern California, 2 groups of urologists performing robot-assisted radical prostatectomy (RARP) were followed since the time of robot acquisition at a single institution. The robotics group included 4 surgeons with formal robotics training and the laparoscopic group with another 4 surgeons who were robot-naïve, but skilled in laparoscopy. The laparoscopic group underwent an initial 7-day mentorship period. Surgical proficiency was measured by various operative and pathological outcome variables. Data were evaluated using comparative statistics and multivariate analysis.

Results: A total of 420 and 549 RARPs were performed by the robotics and laparoscopic groups, respectively. Operative times were longer in the laparoscopic group (p = 0.002), but estimated blood loss was similar. The robotics group had a significantly better overall positive surgical margin rate of 19.9% compared to the laparoscopic group (27.8%) (p = 0.005). Both groups showed improvements in operative and pathological parameters as they accrued experience, and achieved similar results towards the end of the study.

Conclusions: Robot-naïve laparoscopic surgeons may achieve similar outcomes to robotic surgeons relatively early after a graduated mentorship period. This study may apply to a community-based practice in which multiple urologists with varied training backgrounds are granted robot privileges.

Published
2013-11-08
How to Cite
Chang, A., Derboghossians, A., Kaswick, J., Kim, B., Jung, H., Slezak, J., Wuerstle, M., Williams, S. G., & Chien, G. W. (2013). Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons. Canadian Urological Association Journal, 7(11-12), e711-5. https://doi.org/10.5489/cuaj.360
Section
Original Research