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

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.