More time may be required to reach expert level in robotic prostate surgery
ASCO 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 study.
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 said.
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,” Sooriakumaran said.
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 per year.
For more information:
- Sooriakumaran P. #102. Presented at: the ASCO 2011 Genitourinary Cancers Symposium; Feb 15-19, 2011; Orlando, Fla.
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