58 Robotic laparoscopic radical prostatectomy for non‐laparoscopic surgeons ‐ what is the learning curve?

Abstract

Introduction: Laparoscopic radical prostatectomy (LRP) has been shown to have many advantages over open surgery, but has proven difficult for many to become adept at. The use of the Da Vinci® robotic system greatly facilitates the performance of LRP. We set out to analyse how many cases it takes to become proficient at Robotic Assisted Laparoscopic radical Prostatectomy (RALRP).Methods and Methods: Two experienced open surgeons began performing RALRP using the Da Vinci® robotic system in December 2003. Duration of various steps were measured prospectively. Results were grouped sequentially in groups of 10 patients and analysed statistically to determine at what point these results reflected increased operative proficiency. Surgeons results were analysed separately to provide internal validation.Results: One hundred and ten consecutive patients were evaluated. Overall operative times for both surgeons decreased significantly (P < 0.05) over the first 30 cases after which they plateaued at an average of 191 min (36.3% reduction). Actual operative time also decreased significantly (P < 0.01) at or before the 30th case until plateauing at 146 min (39% reduction).Conclusion: RALRP is a procedure that can be mastered much more quickly than standard LRP by experienced open surgeons inexperienced in laparoscopic surgery, with surgical proficiency being attained at/before the 30th case.