2011 Genitourinary Cancers Symposium
ORLANDO — Surgeons may need to perform more than
1,500 robotic-assisted laparoscopic radical prostatectomy procedures to fully
optimize results, according to findings presented here.
Prasanna Sooriakumaran, PhD, a visiting fellow in
urology at the Weill Cornell Medical College in New York, presented data from a
study involving 3,794 patients who underwent the procedure. Three surgeons at
three centers in the US and Europe performed all of the procedures in the
Sooriakumaran said the learning curve for
this procedure may be shorter than for other surgical
modalities, but that the time to fine-tune the details may be steeper.
“We wanted to find out how long it takes to achieve
expert level,” he said. “The learning curve with regard to safety has
been estimated at 25 to 40 procedures. We wanted to look at variables such as
positive surgical margin rate and operative time.”
Sooriakumaran said about 1,500 cases were required for
the learning curve for positive surgical margin rates to decrease to less than
10% when pT3 patients were considered.
“Operating times plateaued at around 750 to 1,000
cases but began to increase again with further surgical experience,” he
The researchers concluded that the learning curve for
robotic prostatectomy may be longer than previously
estimated. “Although relatively limited experience was sufficient to get a
safe result, more experience was necessary to optimize results,”
Robotic-assisted laparoscopic radical prostatectomy
should not be performed in smaller community hospital settings due to the high
number of procedures required for expertise. “This modality is best used
by high-volume surgeons in high-volume settings to optimize patient
outcomes,” he said.
The study was conducted between January 2003 and
September 2009. The aim was to determine the surgical learning curve for
positive margins rates and operating time.
Sooriakumaran said more than 70,000 robotic-assisted
prostatectomy procedures are performed each year in the US. However, about 70%
of them are performed by doctors who perform the procedure fewer than 100 times
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