Robotic-assisted radical prostatectomy: learning curves and outcomes from an Australian perspective

Sachin Perera, Nadil Fernando, Jonathan O'Brien, Declan Murphy, Nathan Lawrentschuk, Sachin Perera, Nadil Fernando, Jonathan O'Brien, Declan Murphy, Nathan Lawrentschuk

Abstract

Background: Robot-assisted radical prostatectomy (RARP) has been a treatment for men who suffer from intermediated to high-risk prostate cancer in Australia since 2003. The primary outcomes in relation to learning curves in robotic surgery have been extensively researched in overseas populations, but there is no study from a cohort of Australian surgeons performing RARP. This study aims to highlight the effect of RARP learning curves on primary surgical outcomes in a high-volume Australian centre.

Methods: A retrospective audit of all RARP performed at Epworth Healthcare from 2016 to 2021 was performed. The primary outcome data collected included operating time (OT), estimated blood loss (EBL), and positive surgical margins (PSM). Exclusion criteria were applied. Positive outcomes were set at OT 240 min, blood loss 310 mL, and negative surgical margins.

Results: A total of 3969 cases were analysed for a cohort of 53 surgeons. Of these surgeons, 24 surgeons have performed >50 operations to be able to undergo learning curve analysis. The median OT was 229 min, the median blood loss was 353 mL, and most cases had negative surgical margins (>1 mm, n = 3681, 92.7%). The mean learning curve transition point was 65 cases. There was a significant difference in the EBL and rate of PSM for the higher volume cohort (p = 0.002 and <0.0001, respectively).

Conclusion: We perform a retrospective study of all RARP performed at a high-volume Australian centre. Higher volume surgeons demonstrate that primary outcomes improve with a higher caseload (EBL, PSM). Learning curve transition points for RARP are comparable to international high-volume surgeons. Learning curve data could form the benchmark for RARP training and skills development.

Keywords: Australian; High-volume; Learning curve; Primary outcomes; Robotic prostatectomy; Surgical oncology.

Conflict of interest statement

None to declare.

© 2022 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Transition points for the HVC calculated by the number of cases required to achieve at least two positive primary outcomes for greater than 50% of the case load, N = 3413. The X-axis represents surgeons numbered 1-24 in the HVC. The Y-axis represents RARP cases for the HVC. HVC, high value cohort; RARP, robot-assisted radical prostatectomy.
Fig. 2
Fig. 2
Median operating time for the first (blue) and last (orange) 50 cases performed by each surgeon in the HVC. X-axis represents surgeons in the HVC, and Y-axis is operating time (including robot docking time) in minutes. The average OT for the first and last 50 cases were 229 and 228, respectively. HVC, high value cohort; OT, operating time.
Fig. 3
Fig. 3
Mean estimated blood loss for the first (blue) and last (orange) 50 cases performed by the HVC. X-axis represents surgeons in the HVC, and Y-axis represents the mean EBL in milliliter. The mean EBL for the first and last 50 cases were 341 and 298 mL, respectively. HVC, high value cohort; EBL, estimated blood loss.
Fig. 4
Fig. 4
Mean PSM for the first (blue) and last (orange) 50 cases in the HVC. The X-axis represents surgeons in the HVC, and the Y-axis represents the rate of PSM >0.2 mm. The rate of PSM for the first and last 50 cases were 18% and 7%, respectively. HVC, high value cohort; PSM, positive surgical margins

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Source: PubMed

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