Training of robotic-assisted radical prostatectomy, experiences of 100 cases

Abstract

Abstract Introduction: The application of robotics in endoscopic techniques becomes commonly in Vietnam. The transition from conventional surgery and laparoscopy to robotic-assisted endoscopy has its own difficulties and advantages. We summarize the experiences of training this procedure through 100 prostate cancers treated by robotic-assisted laparoscopic surgery in the Urology Department, Binh Dan Hospital, from December 2016 to June 2018. Material and Methods: This was a clinical comparative and vertical study. 100 patients diagnosed prostate cancer, staged T1 to T3 were performed robotic-assisted radical prostatectomy (RARP), with or without nerve sparing and local pelvic lymph nodes dissection. The comparison of 5 groups of surgeons, two phases with 50 cases each was conducted. Research variables: Stages of cancer, pre and postoperative PSA levels, Gleason score, lymph node metastases, estimated blood loss, surgery duration, urinary incontinence, hospitalization stay and complications are enrolled . Results: Five surgeons A, B, C, D, E had 38,22,18,14 and 6 cases respectively. The mean age, PSA and cancer stage were statistically similar (p> 0,3). The surgery duration were 176.81, 274.77, 231.88, 286.92 and 272.50 minutes, respectively, which was statistically different (p <0.01). Mean blood loss were 404.62, 476.64, 370, 244.62, 462.50 ml, which was statistically different (p <0.01). 15 cases needed blood transfusion. Hospitalization was 5.42, 11.14, 4.94, 6.31, 7 days, which was not statistically similar among groups (p <0.05), but had a statistically significant relationship with drainage duration and complication rate of each group (p <0.01). The second phase of the study significantly improved in surgery duration from 270 to 214.65 minutes compared to the first phase. Mean blood loss increased from 361.60 to 427.44 ml although the average PSA decreased from 42.84 to 35.72 ng/ml. Lymphadectomy in the first half was 22/50 and in the second half was 29/50. The learning curve of the operation duration reached after 20 cases, however there was little improvement afterwards. More members of surgical team had, more standard deviation of surgical duration was. Conclusion: By studying the training of robotic-assisted radical prostatectomy at Binh Dan Hospital we found that surgery could be safely with acceptable complications. Optimal learning curve for surgical duration was achieved at the first 20 cases. Training needed to have a procedure in place to replicate the number of surgeons without compromising the overall outcome.