Robot‐assisted radical prostatectomy [RARP] experience.

[pjoshea13]

New study.

I had open surgery 14 years ago. When RARP became more available I believe that it was oversold to patients, in the sense that experience was lacking. I kept reading that it took a lot of operations to become proficient.

My friend & neighbor Jim rushed into RARP & his first day home woke up in a pool of his blood. His wife rushed him to the ER, which was lucky because he also had two clots in his lungs.

These days it has to be easy to find someone with a lot of experience. How about 750 cases? Not enough! Look for over 2,000 cases.

In the new study, those with 2,100-3,500 cases outperformed those with 100-750.

"Despite similar PSA and Gleason score, super experts out‐performed experts clinically in regards to peri‐operative outcomes with a greater lymph node yield of 22.6 vs. 14.9 nodes, respectively .., less blood loss (125 vs. 130cc, respectively ...), and less readmissions at 30 days (1% vs. 13%, respectively ...). There was a similar but non‐significant trend seen for oncologic and functional outcomes with super experts having a lower rate of PSA recurrence compared to experts (5% vs. 15%, respectively ...) and a higher continence rate at 3 months (36% vs. 18%, respectively ...)."

I post this in case we get asked for advice.

-Patrick

onlinelibrary.wiley.com/doi...

Experts versus Super Experts: Differences in Automated Performance Metrics and Clinical Outcomes for Robot‐Assisted Radical Prostatectomy

Andrew J. Hung Paul J. Oh Jian Chen Saum Ghodoussipour Christianne Lane Anthony Jarc Inderbir S. Gill

First published: 25 October 2018

doi.org/10.1111/bju.14599

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bju.14599

About

Abstract

Objectives

To evaluate automated performance metrics (APMs) and clinical data of experts and super experts for the four cardinal steps of robot‐assisted radical prostatectomy (RARP) ‐ bladder neck dissection, pedicle dissection, prostate apex dissection, and the vesico‐urethral anastomosis.

Subjects and methods

APMs (motion tracking and system events data) and synchronized surgical video were captured during RARP. APMs were compared amongst two experience levels: experts (100‐750 cases) and super experts (2100‐3500 cases). Clinical outcomes (perioperative, oncologic, functional) were then compared between the two groups. APMs and outcomes were analyzed for 125 RARPs using multi‐level mixed‐effect modeling.

Results

For the four cardinal steps, super experts showed differences in select APMs compared to experts (p<0.05). Despite similar PSA and Gleason score, super experts out‐performed experts clinically in regards to peri‐operative outcomes with a greater lymph node yield of 22.6 vs. 14.9 nodes, respectively (p<0.01), less blood loss (125 vs. 130cc, respectively, p<0.01), and less readmissions at 30 days (1% vs. 13%, respectively, p=0.02). There was a similar but non‐significant trend seen for oncologic and functional outcomes with super experts having a lower rate of PSA recurrence compared to experts (5% vs. 15%, respectively, p=0.13) and a higher continence rate at 3 months (36% vs. 18%, respectively, p=0.14).

Conclusion

We show that experts and super experts differ significantly in select APMs for four cardinal steps of RARP, indicating that surgeons do continue to improve in performance even after achieving expertise. We hope to ultimately identify associations between APMs and clinical outcomes to tailor interventions to surgeons and optimize patient outcomes.

This article is protected by copyright. All rights reserved.

[cesanon]

I think this is true generally about all docs and all professions.

Previously I had been told that it took 500 prostatectomies to become good at it.

[spinosa]

When I was first diagnosed in 2002 - I don't know why, but I asked the urologist I was seeing how many surgeries she'd done: fewer than 100. I went to Mayo Clinic...urologist there do about 40 per month. Walsh's book brings up this point, too.

[Hidden]

I asked my second opinion urologist about RARP in my situation -- I had had TURP surgery for BPH years earlier. He had done several hundred surgeries but only 3 on prior TURP patients. He didn't say no but he was definitely not enthused and neither was my original urologist, who recommended radiation. I went with HIFU instead. I guess the jury is still out on how that will work out. There was no way I was going to go with conventional RP surgery.