Robot-Assisted Laparoscopic Prostatectomy: The First 100 Patients—Improving Patient Safety and Outcomes

Abstract

Patient safety and outcomes are paramount when using new technology. We report our initial experience of 100 patients with robot-assisted laparoscopic prostatectomy (RALP) with a focus on patient safety and outcomes. Data were prospectively collected from the first 100 consecutive patients who underwent RALP for localized prostate cancer from October 2004 to August 2007. To determine our learning curve, the cases were divided into quarters of 25 patients and stratified to identify trends. Mean age was 59.4 years (range 44.5-72.6 yrs), body mass index was 28.4 (range 20.4-40.1), preoperative prostate-specific antigen (PSA) level was 5.7 ng/mL (range 0.4-15.0 ng/mL), and follow-up was 12.7 months (range 7 days-38 mos). Mean operative time was 5.9 hours (range 3.7-10.9 hr), and estimated blood loss (EBL) was 218 mL (range 25-600 mL). Thirty bilateral pelvic lymphadenectomies were performed. Twelve patients had pT(2a) disease, 3 had T(2b), 61 had T(2c), 22 had T(3a)N(0), and 1 had T(3b)N(1). Positive surgical margin rate was 23%. Overall complication rate was 26%. At last follow-up, 88% (76/86) of patients had undetectable PSA levels, and 80% (70/87) of patients were using no pads. Improvement in EBL and operative time was noted throughout the series, and changes in surgical technique and perioperative management were made to improve patient safety and outcomes. RALP perioperative parameters improved throughout the first 100 cases, while postoperative outcomes remained acceptable. Methods to improve patient safety and outcome occurred throughout the series. Even during the initial learning curve for this procedure, RALP appears to be another alternative for achieving prostate cancer control.