Peroperative, oncological, functional learning curves of robot assisted laparoscopic radical prostatectomy (RALP) in a high volume hospital [Perioperatieve, oncologische en functionele leercurves van robotgeassisteerde laparoscopische radicale prostatectomie (RALP) in een hoogvolumeziekenhuis]

Peroperative, oncological, functional learning curves of robot assisted laparoscopic radical prostatectomy (RALP) in a high volume hospital Objective: Analysis of per-operative, oncological and functional learning curves of robot assisted laparoscopic radical prostatectomy (RALP) in a high volume hospital. Methods: Prospective data collection of 416 patients who underwent a RALP between January 2009 and March 2011 in our hospital, performed by one single surgeon. One year follow-up with validated questionnaires. Results: The average consoletime was 129 minutes, bloodloss 321 mls, hospital stay 3,6 days and catheterisation time 7,7 days. Complications occurred in 8% of patients. Positive surgical margin rate was 16% (12% in pT2 and 28% in pT3 group). There was no PSA recurrence in 88% (92% in pT2 and 76% in pT3 group). Percentage of continence was 87%, erection 54%, bifecta 76% and trifecta 54%. Consoletime, hospital stay, erection and positive surgical margins showed a beneficial trend when the number of operated patients increased. Conclusion: RALP is a safe intervention with longer learning curve then previously assumed. After approximately 200 procedures, positive surgical margin rates decrease significantly below 10% in the pT2 group. A significantly descending trend is observed with regard to consoletime and hospital stay. A positive trend is visible regarding erection recovery. Surgeons have the responsibility to render realistic expectations of outcome to patients, based on their own data. © 2013 Bohn Stafleu van Loghum.