Robot-assisted laparoscopic prostatectomy: analysis of an experienced open surgeon's learning curve after 300 procedures.

ABSTRACT

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery. From February 2006 to July 2009, 300 patients underwent a robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. This study is a prospective analysis of the baseline patient and tumour characteristics, intraoperative and postoperative data, and histopathologic features. To analyse the RALP learning curve, the joinpoint regression method was used. Mean age of the patient was 61.3 years (range 46-76). Mean pre-operative PSA level was 7 ng/ml (range 0.7-41), and follow-up was 14 months (0.7-41). The mean operating time was 185 min (range 119-525). One hundred and ten cases were required to achieve 3-h proficiency. There were no conversions. The mean hospital stay was 2.8 days (range 2-7). Major complications rate was 1.3%. The blood transfusion rate was 0.6%. The overall positive surgical margin (PSM) rate was 21.3%. pT2 and pT3 PSM rate was 10 and 44%, respectively. The joinpoint regression method showed that the learning curve started to plateau for the overall PSM rate after 205 cases (95% CI 200-249). For pT2 and pT3, PSM rate, the learning curve tended to flatten after 130 and 170 cases, respectively. The analysis of an experienced open surgeon learning curve in transferring his skills to the robotic platform has shown that 3-h proficiency requires 110 cases. The overall, pT2, and pT3 PSM rate take approximately 200, 130, and 170 cases, respectively, to flatten.