Learning curve for Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP): Experience of two high volume UK surgeons
BAUS ePoster online library. Umari P. 06/21/21; 319063; p2-5
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Paolo Umari
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Abstract
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Introduction:Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP) is a novel robotic surgical technique that is considered more difficult than standard RARP due to limited surgical space and lack of surgical landmarks. We evaluated the learning curve of two UK surgeons performing RS-RARP.
Patients and Methods:An analysis of prospectively collected data for 260 consecutive private patients undergoing RS-RARP from April 2017 to November 2020, divided into tertiles temporally, was performed. Perioperative and pentafecta outcomes were analyzed by tertile and Patient-Reported Outcome Measures (PROMs) for urinary function, erectile function and Quality-of-Life (QoL) were reported at baseline and at 7 days, and 1,3,6,9 and 12 months postoperatively.
Results:Patient and tumor characteristics were similar across tertiles. The mean operative time was 147.00±36.31 minutes and the mean estimated blood loss was 196.46±123.34 milliliters, both of which significantly reduced as the number of cases increased (p<0.001). The mean length of stay was 2.19±1.41 days and 6% of patients had Clavien-Dindo ≥2 complications, both of which were consistent across tertiles. The rates of Positive Surgical Margins (PSM) decreased significantly across tertiles (23.0% vs 19.5% vs 11.6%; p=0.053). Immediate potency rates improved significantly (9.3% vs 17.2% vs 27.9%; p=0.006) while immediate continence rate stayed similar across tertiles (overall, 76.9%). PROMs for urinary continence and QoL scores were also similar across tertiles.
Conclusion:The RS-RARP approach is safe and has excellent patient outcomes. There is improvement in operative time, blood loss, and margin rates with surgical experience, but importantly, surgeons are able to get excellent functional outcomes right from the outset.
Patients and Methods:An analysis of prospectively collected data for 260 consecutive private patients undergoing RS-RARP from April 2017 to November 2020, divided into tertiles temporally, was performed. Perioperative and pentafecta outcomes were analyzed by tertile and Patient-Reported Outcome Measures (PROMs) for urinary function, erectile function and Quality-of-Life (QoL) were reported at baseline and at 7 days, and 1,3,6,9 and 12 months postoperatively.
Results:Patient and tumor characteristics were similar across tertiles. The mean operative time was 147.00±36.31 minutes and the mean estimated blood loss was 196.46±123.34 milliliters, both of which significantly reduced as the number of cases increased (p<0.001). The mean length of stay was 2.19±1.41 days and 6% of patients had Clavien-Dindo ≥2 complications, both of which were consistent across tertiles. The rates of Positive Surgical Margins (PSM) decreased significantly across tertiles (23.0% vs 19.5% vs 11.6%; p=0.053). Immediate potency rates improved significantly (9.3% vs 17.2% vs 27.9%; p=0.006) while immediate continence rate stayed similar across tertiles (overall, 76.9%). PROMs for urinary continence and QoL scores were also similar across tertiles.
Conclusion:The RS-RARP approach is safe and has excellent patient outcomes. There is improvement in operative time, blood loss, and margin rates with surgical experience, but importantly, surgeons are able to get excellent functional outcomes right from the outset.
Introduction:Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP) is a novel robotic surgical technique that is considered more difficult than standard RARP due to limited surgical space and lack of surgical landmarks. We evaluated the learning curve of two UK surgeons performing RS-RARP.
Patients and Methods:An analysis of prospectively collected data for 260 consecutive private patients undergoing RS-RARP from April 2017 to November 2020, divided into tertiles temporally, was performed. Perioperative and pentafecta outcomes were analyzed by tertile and Patient-Reported Outcome Measures (PROMs) for urinary function, erectile function and Quality-of-Life (QoL) were reported at baseline and at 7 days, and 1,3,6,9 and 12 months postoperatively.
Results:Patient and tumor characteristics were similar across tertiles. The mean operative time was 147.00±36.31 minutes and the mean estimated blood loss was 196.46±123.34 milliliters, both of which significantly reduced as the number of cases increased (p<0.001). The mean length of stay was 2.19±1.41 days and 6% of patients had Clavien-Dindo ≥2 complications, both of which were consistent across tertiles. The rates of Positive Surgical Margins (PSM) decreased significantly across tertiles (23.0% vs 19.5% vs 11.6%; p=0.053). Immediate potency rates improved significantly (9.3% vs 17.2% vs 27.9%; p=0.006) while immediate continence rate stayed similar across tertiles (overall, 76.9%). PROMs for urinary continence and QoL scores were also similar across tertiles.
Conclusion:The RS-RARP approach is safe and has excellent patient outcomes. There is improvement in operative time, blood loss, and margin rates with surgical experience, but importantly, surgeons are able to get excellent functional outcomes right from the outset.
Patients and Methods:An analysis of prospectively collected data for 260 consecutive private patients undergoing RS-RARP from April 2017 to November 2020, divided into tertiles temporally, was performed. Perioperative and pentafecta outcomes were analyzed by tertile and Patient-Reported Outcome Measures (PROMs) for urinary function, erectile function and Quality-of-Life (QoL) were reported at baseline and at 7 days, and 1,3,6,9 and 12 months postoperatively.
Results:Patient and tumor characteristics were similar across tertiles. The mean operative time was 147.00±36.31 minutes and the mean estimated blood loss was 196.46±123.34 milliliters, both of which significantly reduced as the number of cases increased (p<0.001). The mean length of stay was 2.19±1.41 days and 6% of patients had Clavien-Dindo ≥2 complications, both of which were consistent across tertiles. The rates of Positive Surgical Margins (PSM) decreased significantly across tertiles (23.0% vs 19.5% vs 11.6%; p=0.053). Immediate potency rates improved significantly (9.3% vs 17.2% vs 27.9%; p=0.006) while immediate continence rate stayed similar across tertiles (overall, 76.9%). PROMs for urinary continence and QoL scores were also similar across tertiles.
Conclusion:The RS-RARP approach is safe and has excellent patient outcomes. There is improvement in operative time, blood loss, and margin rates with surgical experience, but importantly, surgeons are able to get excellent functional outcomes right from the outset.
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