Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Concerns exist regarding potential declines in surgical quality during the initial learning curve of robotic surgery.
• A programmatic, multi-surgeon approach was adopted for introducing robotic surgery at the institution.

Purpose of the Study:

• To evaluate patient outcomes during the first year of a new robotic surgery program.
• To assess the safety and efficacy of robotic-assisted radical prostatectomy compared to open surgery.

Main Methods:

• A historical cohort study of 225 radical prostatectomy patients (104 robotic, 121 open) over one year.
• Prospective and retrospective collection of baseline, perioperative, and long-term follow-up data.
• Treatment failure defined as any postoperative radiation, androgen-deprivation therapy, or prostate-specific antigen (PSA) level ≥0.2 ng/mL.

Main Results:

• Robotic prostatectomy cohort showed significantly lower estimated blood loss (280 cc vs. 760 cc) and transfusion rates (0% vs. 8.3%).
• Robotic surgery resulted in a shorter mean hospital stay (1.4 vs. 2.5 days) without increased non-transfusion complications.
• At 3.5-year follow-up, robotic patients had higher rates of continence (89% vs. 77%) and potency (48% vs. 32%), with similar oncological outcomes (positive margin rate, treatment failure).

Conclusions:

• A multi-surgeon, programmatic introduction of robotic prostatectomy is safe and effective at a Canadian academic institution.
• Robotic radical prostatectomy offers potential benefits in terms of perioperative outcomes and functional recovery compared to open surgery.