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Minerva Urologica e Nefrologica 2020 Dec 01

DOI: 10.23736/S0393-2249.20.04077-1


language: English

The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study

Xavier BONET 1, 2 , Marcio C. MOSCHOVAS 2, Fikret F. ONOL 2, Kulthe R. BHAT 2, Travis ROGERS 2, Gabriel OGAYA-PINIES 2, 3, Bernardo ROCCO 2, 4, Maria Chiara SIGHINOLFI 5, Tracey WOODLIEF 6, Francesc VIGUÉS 1, Vipul PATEL 2

1 Hospital Universitari de Bellvitge, Barcelona, Spain; 2 Advent Health Global Robotics Institute, Celebration, FL, USA; 3 Hospital Universitario Rey Juan Carlos, Madrid, Spain; 4 University of Modena and Reggio Emilia, Modena, Italy; 5 Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; 6 Brody School of Medicine, East Carolina University, USA

BACKGROUND: To report the overall results and the learning curve (LC) in salvage robot-assisted radical prostatectomy (sRARP) patients, in terms of morbidity, oncological and functional outcomes in a single surgeon tertiary-referral center.
METHODS: One hundred and twenty patients underwent sRARP by a single surgeon (V.P.) from 2008 to 2018. To assess the trends in the learning experience they were sub-divided in 4 groups of 30 consecutive patients based on date of surgery. The Kaplan- Meier method and regression models were used to identify survival estimations and predictors of potency, continence and biochemical failure (BCF) at 12 months.
RESULTS: As the learning experience for sRALP increased operative time (OT) was significantly shorter (from 139,5 to 121 min) and the amount of nerve-sparing (NS) undertaken increased (from 46 to 80%). While complications rate remained stable, estimated blood loss (EBL) and radiographic anastomotic leaks (RAL) decreased through the groups (from 124 to 69 ml and 40% to 16,7%, respectively). BCF and continence rates at 12 months after sRARP were similar among groups (23-36% and 36,7-50%, respectively) and chance of potency rates tended to increase (from 3,3% to 16-23%) but was not statistically significant. In a multivariate analysis, predictors for BCF were PSM and GS 8-10. Non-radiation primary treatment was the unique predictor of continence at 12 months after sRARP.
CONCLUSIONS: Our data may suggest a decreasing trend in terms of OT and EBL through the sRARP learning curve. While morbidity remained stable through the time, radiographic anastomotic leaks trended towards a decline. A higher degree of NS was observed through the groups and there was a slight correlation trend between surgical expertise and potency recovery. PSM and GS 8-10 were predictors of BCF and non-radiation primary treatment predicted a better continence after sRARP.

KEY WORDS: Salvage robotic-assisted prostatectomy; Learning curve; Surgical experience; Surgical technique; Erectile function; Continence

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