Efficiency and Outcomes of Robotic Surgery During the First Year of Implementation Using a Multi-surgeon Team Approach
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Abstract
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Introduction and Objectives: To report our multi-surgeon team approach to initiating a robotic surgery program in Canada. Method: We
reviewed the first year of robot assisted laparoscopic prostatectomy (RALRP) at our institution, from October 31, 2011 to October 31,
2012. Multiple surgeons performed the procedure, with a consistent surgical team and clinical care pathway. The time to perform each
component of the procedure was recorded by the nursing staff. An independent data collector obtained pre- and post-operative
information from the medical record. Results: During the study period, 4 urologists performed a total of 104 RALRPs. The median PSA was
6.0 ng/ml (range 1.8 to 41) and median prostate volume was 32 cc (range 13-75). The Gleason score was 6 in 25 (24%), 7 in 65 (62.5%),
8 in 10 (9.6%) and 9 in 4 (3.9%) patients. Forty (39%) patients had extraprostatic tumour extension. The mean total operative time was
263 (SD 81) minutes with a linear decrease from approximately 338 minutes to 230 minutes (-1.0 minutes/case; p<0.001) during the
study period. The time required for anesthesia decreased from approximately 24 to 15 minutes (p=0.004) and the mean surgeon time
decreased from approximately 225 to 175 minutes (p=0.01). The mean times required to dock the robot (7+/-3 minutes) and extract the
prostate/leave the operating room (31+/-7 minutes) were consistent over time (p>0.05). There were no intraoperative complications or
conversions to an open approach. Post-operatively, 5 had anastomotic leak, 2 received a blood transfusion, 2 had urinary tract infection,
2 required catheter reinsertion, and 1 had pneumonia. The mean hospital stay was 1.45 (SD 0.66) days (range 1-5 days). Thirty-eight
(36.5%) patients had a positive surgical margin. Sixty-two (60%) were completely continent at 3-months post-op. At last follow-up, 25 of
50 (50%) patients with bilateral nerve preservation had satisfactory return of erectile function for sexual intercourse with or without PDE-5
inhibitors. Conclusions: Using a multi-surgeon team, RALRP has been safely implemented at our institution. Comparing these results to the
single-surgeon experience may help determine the optimal method for initiating robotic surgery programs at other institutions.
reviewed the first year of robot assisted laparoscopic prostatectomy (RALRP) at our institution, from October 31, 2011 to October 31,
2012. Multiple surgeons performed the procedure, with a consistent surgical team and clinical care pathway. The time to perform each
component of the procedure was recorded by the nursing staff. An independent data collector obtained pre- and post-operative
information from the medical record. Results: During the study period, 4 urologists performed a total of 104 RALRPs. The median PSA was
6.0 ng/ml (range 1.8 to 41) and median prostate volume was 32 cc (range 13-75). The Gleason score was 6 in 25 (24%), 7 in 65 (62.5%),
8 in 10 (9.6%) and 9 in 4 (3.9%) patients. Forty (39%) patients had extraprostatic tumour extension. The mean total operative time was
263 (SD 81) minutes with a linear decrease from approximately 338 minutes to 230 minutes (-1.0 minutes/case; p<0.001) during the
study period. The time required for anesthesia decreased from approximately 24 to 15 minutes (p=0.004) and the mean surgeon time
decreased from approximately 225 to 175 minutes (p=0.01). The mean times required to dock the robot (7+/-3 minutes) and extract the
prostate/leave the operating room (31+/-7 minutes) were consistent over time (p>0.05). There were no intraoperative complications or
conversions to an open approach. Post-operatively, 5 had anastomotic leak, 2 received a blood transfusion, 2 had urinary tract infection,
2 required catheter reinsertion, and 1 had pneumonia. The mean hospital stay was 1.45 (SD 0.66) days (range 1-5 days). Thirty-eight
(36.5%) patients had a positive surgical margin. Sixty-two (60%) were completely continent at 3-months post-op. At last follow-up, 25 of
50 (50%) patients with bilateral nerve preservation had satisfactory return of erectile function for sexual intercourse with or without PDE-5
inhibitors. Conclusions: Using a multi-surgeon team, RALRP has been safely implemented at our institution. Comparing these results to the
single-surgeon experience may help determine the optimal method for initiating robotic surgery programs at other institutions.
Introduction and Objectives: To report our multi-surgeon team approach to initiating a robotic surgery program in Canada. Method: We
reviewed the first year of robot assisted laparoscopic prostatectomy (RALRP) at our institution, from October 31, 2011 to October 31,
2012. Multiple surgeons performed the procedure, with a consistent surgical team and clinical care pathway. The time to perform each
component of the procedure was recorded by the nursing staff. An independent data collector obtained pre- and post-operative
information from the medical record. Results: During the study period, 4 urologists performed a total of 104 RALRPs. The median PSA was
6.0 ng/ml (range 1.8 to 41) and median prostate volume was 32 cc (range 13-75). The Gleason score was 6 in 25 (24%), 7 in 65 (62.5%),
8 in 10 (9.6%) and 9 in 4 (3.9%) patients. Forty (39%) patients had extraprostatic tumour extension. The mean total operative time was
263 (SD 81) minutes with a linear decrease from approximately 338 minutes to 230 minutes (-1.0 minutes/case; p<0.001) during the
study period. The time required for anesthesia decreased from approximately 24 to 15 minutes (p=0.004) and the mean surgeon time
decreased from approximately 225 to 175 minutes (p=0.01). The mean times required to dock the robot (7+/-3 minutes) and extract the
prostate/leave the operating room (31+/-7 minutes) were consistent over time (p>0.05). There were no intraoperative complications or
conversions to an open approach. Post-operatively, 5 had anastomotic leak, 2 received a blood transfusion, 2 had urinary tract infection,
2 required catheter reinsertion, and 1 had pneumonia. The mean hospital stay was 1.45 (SD 0.66) days (range 1-5 days). Thirty-eight
(36.5%) patients had a positive surgical margin. Sixty-two (60%) were completely continent at 3-months post-op. At last follow-up, 25 of
50 (50%) patients with bilateral nerve preservation had satisfactory return of erectile function for sexual intercourse with or without PDE-5
inhibitors. Conclusions: Using a multi-surgeon team, RALRP has been safely implemented at our institution. Comparing these results to the
single-surgeon experience may help determine the optimal method for initiating robotic surgery programs at other institutions.
reviewed the first year of robot assisted laparoscopic prostatectomy (RALRP) at our institution, from October 31, 2011 to October 31,
2012. Multiple surgeons performed the procedure, with a consistent surgical team and clinical care pathway. The time to perform each
component of the procedure was recorded by the nursing staff. An independent data collector obtained pre- and post-operative
information from the medical record. Results: During the study period, 4 urologists performed a total of 104 RALRPs. The median PSA was
6.0 ng/ml (range 1.8 to 41) and median prostate volume was 32 cc (range 13-75). The Gleason score was 6 in 25 (24%), 7 in 65 (62.5%),
8 in 10 (9.6%) and 9 in 4 (3.9%) patients. Forty (39%) patients had extraprostatic tumour extension. The mean total operative time was
263 (SD 81) minutes with a linear decrease from approximately 338 minutes to 230 minutes (-1.0 minutes/case; p<0.001) during the
study period. The time required for anesthesia decreased from approximately 24 to 15 minutes (p=0.004) and the mean surgeon time
decreased from approximately 225 to 175 minutes (p=0.01). The mean times required to dock the robot (7+/-3 minutes) and extract the
prostate/leave the operating room (31+/-7 minutes) were consistent over time (p>0.05). There were no intraoperative complications or
conversions to an open approach. Post-operatively, 5 had anastomotic leak, 2 received a blood transfusion, 2 had urinary tract infection,
2 required catheter reinsertion, and 1 had pneumonia. The mean hospital stay was 1.45 (SD 0.66) days (range 1-5 days). Thirty-eight
(36.5%) patients had a positive surgical margin. Sixty-two (60%) were completely continent at 3-months post-op. At last follow-up, 25 of
50 (50%) patients with bilateral nerve preservation had satisfactory return of erectile function for sexual intercourse with or without PDE-5
inhibitors. Conclusions: Using a multi-surgeon team, RALRP has been safely implemented at our institution. Comparing these results to the
single-surgeon experience may help determine the optimal method for initiating robotic surgery programs at other institutions.
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