Learning Curve for Robot-Assisted Laparoscopic Radical Prostatectomy for Pathologic T2 Disease

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period.
Materials and Methods: Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient’s perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin.
Results: There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p＜0.001) and estimated blood loss (p＜0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680).
Conclusions: Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuously.

다국어 초록 (Multilingual Abstract)

Purpose: To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period.
Materials and Methods: Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient’s perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin.
Results: There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p＜0.001) and estimated blood loss (p＜0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680).
Conclusions: Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuously.

참고문헌 (Reference)

1 반정현, "로봇이용 복강경 근치적 전립선적출술의 학습곡선: 전향적 연구" 대한비뇨기과학회 50 (50): 140-147, 2009

2 이용성, "로봇을 이용한 복강경 근치적 전립선적출술" 대한비뇨기과학회 47 (47): 206-210, 2006

3 박성열, "로봇 보조 복강경 방광적출술 및 회장도관술" 대한비뇨기과학회 49 (49): 506-509, 2008

4 공근수, "da VinciTM Surgical System을 이용한 복강경하 근치적 전립선절제술의 초기 경험" 대한비뇨기과학회 46 (46): 353-359, 2005

5 Ahlering TE, "Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy" 170 : 1738-1741, 2003

6 Binder J, "Robotically-assisted laparoscopic radical prostatectomy" 87 : 408-410, 2001

7 Pasticier G, "Robotically assisted laparoscopic radical prostatectomy: feasibility study in men" 40 : 70-74, 2001

8 Wolfram M, "Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique" 21 : 128-132, 2003

9 Bentas W, "Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up" 44 : 175-181, 2003

10 Zorn KC, "Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon" 21 : 441-447, 2007

11 Patel VR, "Robotic radical prostatectomy in the community setting--the learning curve and beyond: initial 200 cases" 174 : 269-272, 2005

12 Ahlering TE, "Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes" 63 : 819-822, 2004

13 Jaffe J, "Robot-assisted laparoscopic prostatectomy: a single-institutions learning curve" 73 : 127-133, 2009

14 Hegarty NJ, "Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques" 13 (13): 56-61, 2006

15 Menon M, "Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience" 60 : 864-868, 2002

16 Sim HG, "Early experience with robot-assisted laparoscopic radical prostatectomy" 27 : 321-325, 2004

17 Tewari A, "A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution" 92 : 205-210, 2003