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Surgical case order does not affect outcomes during robot-assisted radical prostatectomy.

Seth A Capello1, Hitendra R H Patel2, Jean V Joseph3,4

  • 1Section of Laparoscopy and Robotics, University of Rochester, Rochester, NY, USA.

Journal of Robotic Surgery
|September 18, 2016
PubMed
Summary

Performing three robot-assisted radical prostatectomies (RARP) consecutively in one day does not significantly impact patient outcomes. An experienced surgical team can maintain consistent results across multiple RARP cases, regardless of their order.

Keywords:
FatiguePatient evaluationSurgical outcomes

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Area of Science:

  • Urology
  • Surgical Oncology
  • Patient Safety

Background:

  • Fatigue is a known factor in medical errors, yet its impact on surgical outcomes based on case order remains under-explored.
  • The surgical literature lacks data on whether the sequence of procedures affects patient results.

Purpose of the Study:

  • To investigate the influence of case order on surgical outcomes in robot-assisted radical prostatectomy (RARP).

Main Methods:

  • 381 patients undergoing RARP by a single surgeon were divided into three groups based on case order (1st, 2nd, 3rd).
  • Pre-operative, intra-operative, and post-operative parameters were compared across groups.
  • Surgical and medical complications were classified and analyzed.

Main Results:

  • No significant differences were observed in patient demographics, operative time, estimated blood loss, prostate volume, or pathologic Gleason score.
  • A slight trend towards increasing T3 disease was noted with later case order, but positive margin rates were lowest in the third group (3.9%).
  • Overall complication rates were similar (5-7%) across all groups, with no significant variation in PSA recurrence.

Conclusions:

  • Performing three consecutive RARP procedures in a single day is feasible without compromising patient outcomes.
  • An experienced surgical team can maintain high-quality results irrespective of case order in RARP procedures.