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Robotic-assisted radical prostatectomy—impact of a mentorship program on oncological outcomes during the learning curve

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background and aims

The learning curve for robotic-assisted radical prostatectomy (RARP) is estimated to be about 50–200 cases. This study will evaluate the benefit of a mentorship programme after completing a mini-fellowship in RARP by an experienced surgeon who previously trained in open and laparoscopic surgery.

Methods

Our study was a retrospective comparative analysis of RARP performed by a single consultant urologist. A retrospective chart review of the first 120 cases was performed. The 120 patients were divided into three groups of 40 cases. For the first 40 cases, an appropriately qualified mentor was present. The peri-operative and oncological outcomes were compared between the three groups.

Results

Operative times significantly decreased with experience (250 min vs 234 min vs 225 min, p < 0.05). Complication rates, estimated blood loss, and length of stay were similar between all groups. There was a higher rate of positive margins in the final group (20% vs 17.5% vs 32.5%, p < 0.5). There was a greater number of pT3 tumours in group 3 (42%, n = 17) compared to groups 1 and 2 (20%, n = 8, and 22.5%, n = 9) which may account for the higher rate of positive margins in this group.

Conclusion

In the transition of an experienced laparoscopic surgeon to robotic surgery, we showed that there is a benefit of a mentorship programme after a mini-fellowship in reducing the impact of the learning curve on patient outcomes. Ongoing mentorship may be of benefit in cases where a high volume of tumour is suspected and should be avoided in the early part of the learning curve to maximise oncological outcomes.

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Abbreviations

RARP:

Robotic-assisted robotic prostatectomy

BAUS:

British Association of Urological Surgery

ERUS:

European Association of Urology Robotic Urology Section

RP:

Radical prostatectomy

ISUP:

International Society of Urological Pathology

ERAS:

Enhanced recovery assessment protocol

IHD:

Ischaemic heart disease

EBL:

Estimated blood loss

IV:

Intravenous

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Funding

The authors received no funding as part of this study.

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Authors and Affiliations

  1. Department of Urology, St. Vincent’s University Hospital, Dublin, Ireland

    James P. C. Ryan, Olwyn Lynch, Mark P. Broe, Diarmaid Moran, Barry McGuire & David Mulvin

  2. Department of Histopathology, St. Vincent’s University Hospital, Dublin, Ireland

    Niall Swan

Authors
  1. James P. C. Ryan
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  2. Olwyn Lynch
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  3. Mark P. Broe
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  4. Niall Swan
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  5. Diarmaid Moran
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  6. Barry McGuire
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  7. David Mulvin
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Correspondence to James P. C. Ryan.

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Ryan, J.P.C., Lynch, O., Broe, M.P. et al. Robotic-assisted radical prostatectomy—impact of a mentorship program on oncological outcomes during the learning curve. Ir J Med Sci 191, 479–484 (2022). https://doi.org/10.1007/s11845-021-02556-9

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  • DOI: https://doi.org/10.1007/s11845-021-02556-9

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