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KMID : 0358320090500020140
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Korean Journal of Urology
2009 Volume.50 No. 2 p.140 ~ p.147
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Learning Curve with Robotic-Assisted Laparoscopic Radical Prostatectomy: A Prospective Study
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Ban Jung-Hyun
Park Hong-Seok
Kang Seok-Ho
Cheon Jun
Ko Young-Hwii
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Abstract
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Purpose: To investigate the learning curve and its characteristics in our initial experiences with robotic-assisted laparoscopic radical prostatectomy (RLRP) with a new da Vinci-S surgical system.
Materials and Methods: Through inspection of the patients who underwent RLRP by a single urologic surgeon from July 2007 to May 2008, the variables related to surgery were evaluated prospectively.
Results: RLRP was performed in 50 patients. The patients’ mean age (range) was 63 years (50-73 years), and 11 patients had a history of previous abdominal surgery. The mean total operation time was 281.6 min (190-455 min). The mean set-up time was 18.6 min (14-30 min), and the mean console time was 219.8 min (150-400 min). The mean estimated blood loss (EBL) was 375.7ml (200-800 ml). The overall margin-positive rate was 26% (13/50); it was 11.9% (5/42) for pT2 tumors and 100% (8/8) for pT3 tumors. Minor complications occurred in 5 patients. All complications were treated effectively with only conservative management. The total operation time, set-up time, console time, and EBL significantly decreased as the number of patients treated grew (Spearman’s rank correlation, p<0.05; Rho=?0.49, ?0.35, ?0.54, ?0.75, respectively). The mean total operation time, set-up time, console time, and EBL were significantly decreased in the last 35 patients who needed no transfusion (p<0.05).
Conclusions: The use of robotic surgery allowed the surgeon to complete the learning curve in a relatively short time period, with low perioperative complication rates and potentially good oncologic results, as indicated by the acceptable positive surgical margin in the patients with pathologically organ-confined disease.
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KEYWORD
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Prostatic neoplasms, Prostatectomy, Robotics, Laparoscopy
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