Robotic-assisted laparoscopic prostatectomy (RALP): a new way to training

The implementation of RALP program is usually associated with a steep learning curve (LC). Fellows are proctored for few cases, with long operating times, inferior outcomes and an increased number of complications. We report the initial results of 100 RALP procedures performed in Rio de Janeiro, Brazil, with the implementation of a structured program. Our goal was to evaluate if our approach to training would yield a safer outcomes for patients undergoing the procedure during the LC. From October 2012 to January 2014, five surgeons began a training program in RALP. Each surgeon attended a certification course, wet lab, dry lab, didactic course and observed live cases. Each trainee performed 20 cases of RALP under supervision of an experienced preceptor. The median surgical time was 175 min [interquartile range (IQR) 141-180 min]. There were four complications Clavien II (4 %) and three Clavien IIIa (3 %), no conversions nor transfusions. The median estimated blood loss was 200 ml (IQR 150-300 ml). The median hospital stay was 2 days (IQR 1-2 days). The median catheterization time was 7 days (IQR 6-7 days). Overall positive surgical margin rate (PM) was 19 %; stage-specific PSM rates were 12 % in pT2 and 53 % in pT3. The biochemical recidive-free survival rate (PSA < 0.01 ng/ml) was 91 % over an average follow-up of 6 months. The continence rates were (no pad) 74 % within 3 months and 94 % within 6 months. The implementation of a training program with advanced precepting allowed us to overcome the initial LC with reasonable results and with minimal complications.