Assessment of learning curve for robot assisted laparoscopic prostatectomy on real time basis with case by case evaluation of perioperative outcomes
BAUS ePoster online library. Vasdev N. 11/10/20; 304140; P10-4
Mr. Nikhil Vasdev
Mr. Nikhil Vasdev
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Assessment of learning curve for robot assisted laparoscopic prostatectomy on real time basis with case by case evaluation of perioperative outcomes

Tamhankar A1, Hampson A1, Noel J1, El-Taji O1, Arianayagam R1, Boustead G1, McNicholas T1, Lane T1, Adshead J1, Vasdev N1
1Lister Hospital, Stevenage, United Kingdom

Introduction:
The learning curves analysed till date for robot assisted laparoscopic prostatectomy (RALP) are based on some arbitrary cut offs of the total cases with a fellowship programme.

Methods:
We analysed a large dataset of RALP from a single centre between 2008 and 2019 for assessment of learning curve for perioperative outcomes with respect to time and individual cases.

Results:
1406 patients were evaluated with a mean operative time (OT) and console time (CT) of 198.08 and 161.05 minutes respectively. A plot of OT and CT showed an initial decline followed by a near constant phase. The inflection points were detected at 1398 days (308th case) and 1470 days (324th case) respectively for OT and CT with declining trend of 8.83 minutes and 7.07 minutes per quarter year (p<0.001). Mean estimated blood loss showed 70.04% reduction between start (214.76 ml) and end (64.35 ml) (p<0.001). Complication rate did no vary with respect to time (p 0.188) or number of procedures (p 0.354). There was insufficient evidence to claim that either number of operations (p = 0.326) or D'Amico classification (p = 0.114 for Intermediate vs Low, p = 0.158 for High vs Low) or time (p 0.114) were associated with the odds of positive surgical margins (PSM).

Conclusions:
It takes about 300 cases and nearly 4 years for standardising the operative and console time with an approximate estimation of requirement of around 80 cases per annum for a single surgical team in the initial years for optimising the outcomes of RALP.
Assessment of learning curve for robot assisted laparoscopic prostatectomy on real time basis with case by case evaluation of perioperative outcomes

Tamhankar A1, Hampson A1, Noel J1, El-Taji O1, Arianayagam R1, Boustead G1, McNicholas T1, Lane T1, Adshead J1, Vasdev N1
1Lister Hospital, Stevenage, United Kingdom

Introduction:
The learning curves analysed till date for robot assisted laparoscopic prostatectomy (RALP) are based on some arbitrary cut offs of the total cases with a fellowship programme.

Methods:
We analysed a large dataset of RALP from a single centre between 2008 and 2019 for assessment of learning curve for perioperative outcomes with respect to time and individual cases.

Results:
1406 patients were evaluated with a mean operative time (OT) and console time (CT) of 198.08 and 161.05 minutes respectively. A plot of OT and CT showed an initial decline followed by a near constant phase. The inflection points were detected at 1398 days (308th case) and 1470 days (324th case) respectively for OT and CT with declining trend of 8.83 minutes and 7.07 minutes per quarter year (p<0.001). Mean estimated blood loss showed 70.04% reduction between start (214.76 ml) and end (64.35 ml) (p<0.001). Complication rate did no vary with respect to time (p 0.188) or number of procedures (p 0.354). There was insufficient evidence to claim that either number of operations (p = 0.326) or D'Amico classification (p = 0.114 for Intermediate vs Low, p = 0.158 for High vs Low) or time (p 0.114) were associated with the odds of positive surgical margins (PSM).

Conclusions:
It takes about 300 cases and nearly 4 years for standardising the operative and console time with an approximate estimation of requirement of around 80 cases per annum for a single surgical team in the initial years for optimising the outcomes of RALP.
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