Robotic-assisted radical prostatectomy by a single surgeon in Taiwan: experience with the initial 30 cases

Robotic-assisted laparoscopic radical prostatectomy (RALP) is an established trend in surgical treatment for localized prostate cancer in the USA; however, RALP is still in its infancy in Taiwan. We have tracked various indicators of proficiency as a single Taiwanese surgeon became familiar with the procedure through experience with 30 initial RALP surgeries using the da Vinci system between December 2005 and April 2007. Here, we report the changes in these proficiency indicators, and the short-term outcomes for the patients. Thirty consecutive patients were classified into group 1 (cases 1-15) and group 2 (cases 16-30). Preoperative clinical characteristics, including age, body mass index (BMI), American Society of Anesthesiologists anesthetic surgical risks class (ASA), prostate-specific antigen levels (PSA), and Gleason scores were similar between the groups. The clinical stage (T1/T2) was significantly higher in group 2 than in group 1 (p = 0.028). Group 1 needed more frequent insertion of a double-J stent (60% versus 0%) before surgery and evaluation by cystogram before removal of urethral catheter (80% versus 6.7%) than group 2; these differences were statistically significant. Blood loss and transfusion rates were lower in group 2, but complication and conversion rates were higher in group 1. These differences were not statistically significant. Positive surgical margins, continence rates, potency, and intercourse rates at 12 months were similar between the groups. Console time was 262 min in group 1 and 190 min in group 2 (p = 0.033); this appeared to be the best indicator of proficiency. Establishing proficiency as determined by functional outcomes required about 30 cases, but the positive surgical margin rates indicate that experience with more than 30 cases was needed to ascend the learning curve with respect to oncological outcomes.