High-volume surgeons decrease operating time in robot-assisted radical prostatectomy: results in 1229 patients.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer.
• Factors influencing operative time (OT) in RARP, especially with extended pelvic lymph node dissection (ePLND), require evaluation.
• Understanding OT determinants is crucial for surgical efficiency and resource management.

Purpose of the Study:

• To identify factors impacting operative time (OT) during robot-assisted radical prostatectomy (RARP).
• To assess the influence of surgeon volume and extended pelvic lymph node dissection (ePLND) on RARP OT.
• To analyze the impact of clinical and anatomical variables on RARP OT.

Main Methods:

• A retrospective analysis of 1289 patients undergoing RARP between January 2013 and December 2021.
• Comparison of OT between low-volume surgeons (LVS) and high-volume surgeons (HVS).
• Linear regression models used to assess associations between OT variations and clinical/anatomical factors, including ePLND.

Main Results:

• High-volume surgeons (HVS) significantly reduced RARP OT by approximately 40-43 minutes compared to LVS.
• This OT reduction by HVS was independent of clinical factors like BMI and PV, and anatomical factors like PW and blood loss.
• RARP with ePLND performed by HVS also showed decreased OT, irrespective of various patient and surgical characteristics.

Conclusions:

• Surgeon volume is a key determinant in reducing operative time for RARP.
• HVS performing RARP, with or without ePLND, achieve greater efficiency.
• Optimizing surgical scheduling based on surgeon volume can improve operating room utilization, reduce costs, and enhance training opportunities.