Impact of Robotic Training on Surgical and Pathologic Outcomes During Robot-assisted Laparoscopic Radical Prostatectomy
Kaiser Permanente, Oakland, California, United States Urology
(Impact Factor: 2.19).
03/2010; 76(2):363-8. DOI: 10.1016/j.urology.2009.09.085
To prospectively compare outcomes during robotic prostatectomy between surgeons with formal training in either robotic prostatectomy (RALP) or laparoscopic prostatectomy (LRP).
A total of 286 robotic prostatectomies were performed by 12 urologists between August 2008 and March 2009 as part of a new robotic surgery program at one of the largest health maintenance organizations in the United States. Four surgeons had formal training in RALP and 8 had formal training in LRP. We prospectively compared surgical and pathologic outcomes between these 2 groups of surgeons.
The 4 RALP surgeons performed 121 RALPs and the 8 LRP surgeons performed 165 RALPs. Patient demographics were similar between groups. The robot-naive group had significantly more clinical stage T1c than the robot-trained group (87.9% vs 74.4%, P = .003). Prostatectomy parameters were similar between the 2 groups of surgeons in terms of prostate size, Gleason score, pathologic stage, and estimated blood loss. The robot-trained surgeons had significantly lower overall positive margin rates (24% vs 34.6%, P = .05) and lower margin rates in T3 tumors (38.5% vs 61.8%, P = .07), which were approximately statistically significant. There was no difference in margin rates in T2 tumors. The robot-trained surgeons had significantly lower apical margin rates (8.3% vs 21.2%, P = .003) and lateral margin rates (1.7% vs 7.3%, P = .05). The robot-trained surgeons had 10%-15% shorter procedure times. There was no difference in complication rates.
Formal RALP training may be beneficial for surgical and pathologic outcomes of RALP compared with formal LRP training during the initial implementation of a new robotics program.
Available from: Kamran Ahmed
- "They concluded that surgeons should consider whether they can build enough experience to minimize suboptimal oncological outcomes before embarking on or continuing a RALP program. Kwon et al. attempted to prospectively compare outcomes during robotic prostatectomy between surgeons with formal training in either robotic prostatectomy (RALP) or laparoscopic prostatectomy (LRP) . Twelve urologists conducted 286 robotic prostatectomies of which 4 surgeons had formal training in RALP and 8 had formal training in LRP. "
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ABSTRACT: To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer.
Eight hundred twenty-seven patients with gastric cancer.
Between July 2005 and April 2009, 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed.
We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality.
The robotic group was younger than the laparoscopic group, but other preoperative patient characteristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P < .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P = .002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P > .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1+α (n = 5), D1+β (n = 126), and D2 (n = 105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins.
Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.
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ABSTRACT: To measure and describe the impact of median lobe anatomy on surgical margin status after robot-assisted laparoscopic prostatectomy (RALP).
We prospectively collected median lobe status, surgical margin status, and other perioperative data on 791 patients who underwent RALP at our institution by 12 surgeons between August 2008 and December 2010. We performed univariable and multivariable analysis to measure the association between median lobe status and positive surgical margin rates, including site.
Compared with patients without a median lobe (n=672), patients with a median lobe (n=119) were less likely to have a positive surgical margin (16% vs 24.4%). They had a higher prostate-specific antigen (PSA) level (6.1 ng/dL vs 5.4 ng/dL), lower Gleason scores (<7, 58.1% vs 42.1%), lower pathologic stages (T(2), 87.4% vs 75.4%), and larger prostates (64 g vs 48 g) (all P<0.05). In our multivariable model, the effect of median lobe anatomy on surgical margin status, after adjusting for these factors, was not statistically significant (relative risk 0.97, 95% confidence interval, 0.64-1.47, P=0.88). Lower PSA level, Gleason score, and pathologic stage and larger prostates, however, predicted decreased positive surgical margin rates (P<0.01).
Although presence of median lobe anatomy is not an independent predictor of positive surgical margins in RALP, it is associated with favorable pathologic characteristics that are known to predict decreased positive surgical margins.
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