The Learning Curve Analysis Of Robotic-assisted Laparoscopic Radical Prostatectomy By A Single Surgeon

Objective:To explore the learning curve of robot-assisted laparoscopic radical prostatectomy with rich experience in laparoscopic surgery by a single surgeon.Methods:Since 2013,a urologist has performed more than 1,500 laparoscopic procedures,including more than 150 radical nephrectomy,more than 200 partial nephrectomy,more than 250 adrenalectomy,and more than 60 radical cystectomy,nearly 100 cases of radical prostatectomy and other urological disease.Retrospective analysis of the first affiliated hospital of nanchang university during March 2016 to September 2018 by the same urologist of the early 60 cases of prostate cancer robotic assisted laparoscopic radical prostatectomy(RALRP)clinical data,according to the operation time sequence,were divided into group A(1-15 cases),group B(16-30 cases),group C(31-45 cases)and group D(46-60 cases),Preoperative baseline information and time of operation,intraoperative blood loss and transfusion rate,Number of days in hospital after surgery,catheter indwelling time,postoperative pathological stage,postoperative Gleason score,positive rate of surgical margin,positive rate of lymph node and early complications(28 days)were compared among the groups.The learning curve was plotted with the operative time as a measure.Results:All the 60 cases were successfully completed,and none of them were transferred to hospital.The operative time was 155-430min(excluding the installation time),with an average of 240min;intraoperatve blood soss was 40-1200 ml,median value was 250 ml,and the intraoperative blood transfusion ratio was 6.67%(4/60),all of which occurred in the first 30 cases;and the positive rate of the cutting edge was 33.33%(20/60).The operative time was respectively of A、B、C and D respectively was 292.67±61.26 min,225.0±36.0min,219.67±44.22 min 和 203.08±19.16min;The operative time of the last three groups was significantly less than that of group A,and the difference was statistically significant(P<0.001).Intraoperative blood loss in groups A,B,C and D were 280(150-1000)ml,265(40-900)ml,235(100-1000)ml and 250(80-700)ml,respectively,with no statistically significant difference(P>0.05).In the learning curve,with the increase of the number of surgical cases,the operation time shows a significant downward trend.After about 15 cases of operations in the early stage,the average operation time of RALRP is 215 min,which shows that RALRP enters the learning curve plateau.Conclusion:Urologists with rich experience in traditional laparoscopic surgery are safe and feasible to perform robot-assisted laparoscopic radical prostatectomy;and their learning curve is significantly shortened.It takes about 15 cases to pass the RALRP learning curve.