Does Changeover by an Experienced Open Prostatic Surgeon from Open Retropubic to Robot-Assisted Laparoscopic Prostatectomy Mean a Step Forward or Backward?
We assessed whether changeover from open retropubic [RRP] to robotic-assisted laparoscopic prostatectomy [RALP] means a step forward or backward for the initial RALP patients. Therefore the first 105 RALPs of an experienced open prostatic surgeon and robotic novice—with tutoring in the initial 25 cases—were compared to the most recent 105 RRPs of the same surgeon. The groups were comparable with respect to patient characteristics and postoperative tumor characteristics (all ). The only disadvantage of RALP was a longer operating time; the advantages were lower estimated blood loss, fewer anastomotic leakages, earlier catheter removal, shorter hospital stay (all ), and less major complications within 90 days postoperatively ( ). Positive surgical margin rates were comparable both overall and stratified for pT stage in both groups (all ). In addition, an equivalent number of lymph nodes were removed ( ). Twelve months after surgery, patient reported continence and erectile function were comparably good (all ). Our study indicates that an experienced open prostatic surgeon and robotic novice who switches to RALP can achieve favorable surgical results despite the initial RALP learning curve. At the same time neither oncological nor functional outcomes are compromised. 1. Introduction While robot-assisted urologic surgery has gained widespread acceptance in the United States with 1,789 installed daVinci surgical systems as of June 30, 2012, it is in its infancy in Europe and in the rest of the world with only 400 and 273 installed units, respectively. Thus, there are still a large number of urologic institutions that are faced with the question if or not a robotic surgical system should be acquired [1]. This question is important since the most frequent robotic procedure, namely, radical prostatectomy, is demanded more and more by the patients, and shows a growing body of literature reporting sound results for the robotic approach both in open-retropubic versus robotic comparative studies [2–20] and in robotic-only studies [21–28]. However, despite the promising results published, implementation of a new surgical technique like robotics in a robotic-naive institution does not automatically guarantee an improved outcome for the patient. Rather, it could even mean an unfavorable outcome in the first patients of the learning curve, if an unfavorable outcome is defined as a worse outcome than that which could have been achieved by the previously established technique [29]. For radical prostatectomy in our and many other institutions the established technique for
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