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Abstract

Volume 11, Issue 2 (March 2009) 11, 167–175; 10.1038/aja.2008.52

Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience

Young Hwii Ko1, Jeong Hyeon Ban1, Seok Ho Kang1, Hong Seok Park1, Jeong Gu Lee1, Duck Ki Yoon1, Je Jong Kim1, Jun Cheon1 and Vipul R Patel2

1 Department of Urology, MIS & Robotic Urologic Surgery Center, Korea University School of Medicine, Seoul 136705, Korea
2 Global Robotics Institute, University of Central Florida, Florida Hospital, Orlando, FL 32803, USA

Correspondence: Dr Jun Cheon, Department of Urology, MIS & Robotic Urologic Surgery Center, Korea University School of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 136705, Korea. Fax: +82-2-928-7864 E-mail: jcheon@korea.ac.kr

Received 10 September 2008; Revised 22 October 2008; Accepted 18 November 2008; Published online 19 January 2009

Abstract

To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.

Keywords: learning curve, outcomes assessment, radical prostatectomy, robotics

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