Validation of an educational program balancing surgeon training and surgical quality control during robot-assisted...

To establish a mentoring program that allows novice surgeons to use robotics while maintaining surgical quality during robot-assisted radical prostatectomy.

A total of 242 cases of robot-assisted radical prostatectomy for patients with localized prostate cancer were considered for this study. Each novice surgeon carried out a step-by-step robot-assisted radical prostatectomy procedure by following technical checkpoints and time limits that were established on the basis of previous surgical performance by a mentor. If technical checkpoints could not be accomplished, or the times were being exceeded, a mentor replaced the novice surgeon to finish the operative step or the surgery. Furthermore, if total blood loss exceeded 500 mL, a mentor completed the surgery. The primary end-point was the number of cases required for a new surgeon to successfully complete the entire robot-assisted radical prostatectomy procedure. Clinicopathological outcomes and any cases that deviated more than the standard deviation were also analyzed.

Median patient age, serum prostate-specific antigen level (ng/mL), and Gleason score at diagnosis were 68 years, 7.6 and 7, respectively. Mean console and total operative times were 184 and 237 min, respectively. Mean perioperative blood loss was 300 mL. Seven out of eight new surgeons finished the total procedure after 10.7 cases (range 8-12). Four cases (1.7%) exceeded perioperative total blood loss and operative time. Positive surgical margin rates for total, T2, and T3 were 22, 9.3 and 47%, respectively. Positive surgical margin localized at bladder neck 19%, lateral lobe 39%, apex 32% and peripheral fat 9.4%.

Herein we demonstrate an institutional mentoring program that effectively balances surgeon robot-assisted radical prostatectomy training and surgical quality control.