Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. Can J Urol 2009 16: 4742–4749.ĭoumerc N, Yuen C, Savdie R, Rahman MB, Rasiah KK, Pe Benito R et al. Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. Zorn KC, Wille MA, Thong AE, Katz MH, Shikanov SA, Razmaria A et al. Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications. Murphy DG, Bjartell A, Ficarra V, Graefen M, Haese A, Montironi R et al. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. Eur Urol 2006 49: 866–872.Īhlering TE, Skarecky D, Lee D, Clayman RV. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncological outcomes. Prostate Cancer Prostatic Dis 2007 10: 242–249.Ītug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom. Goldstraw MA, Patil K, Anderson C, Dasgupta P, Kirby RS. Herron DM, Marohn M, SAGES-MIRA Robotic Surgery Consensus Group. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. Zorn CK, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM et al. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.
Rashid HH, Leung YYM, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L. Cancer control and functional outcomes after radical prostatectomy as markers of surgical quality: analysis of heterogeneity between surgeons at a single cancer center. Vickers A, Savage C, Bianco F, Mulhall J, Sandhu J, Guillonneau B et al. We discuss some of the specific techniques to deal with these potential difficulties and highlight ways to avoid making serious mistakes. Approaching these problems in a structured manner allows many of the problems to be overcome. Even experienced robotic surgeons will be challenged by salvage RARP. Significant intra-abdominal adhesions may be identified following open surgery, or dense periprostatic inflammation may be encountered following TURP large prostate gland size and median lobes may alter bladder neck anatomy, making difficult subsequent urethro-vesical anastomosis. Furthermore, as surgeons progress there is a tendency to take on increasingly complex cases, including patients with difficult anatomy and prior surgery, and these cases present a unique challenge. However, robotic surgery is still fraught with potential difficulties and avoiding complications while on the steepest part of the learning curve is critical. Part of the explanation for the rapid uptake of RARP is the reported gentler learning curve compared with the challenges of laparoscopic radical prostatectomy (LRP).
Robot-assisted radical prostatectomy (RARP) is the most commonly performed robotic procedure worldwide and is firmly established as a standard treatment option for localised prostate cancer.
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