| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 6166122 | Urology | 2014 | 6 Pages |
ObjectiveTo assess the impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection for intermediate- or high-risk clinically localized prostate cancer.MethodsFrom November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5Â days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3Â months. Variables were compared using chi-square and Wilcoxon tests.ResultsOverall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (PÂ = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (PÂ <.01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (PÂ = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: PÂ <.01). Renal function was unaltered postoperatively.ConclusionA surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected.
