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Examining the Learning Curve of Robotic Surgery

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Robotic Urologic Surgery

Abstract

The learning curve is can be generally defined as the number of cases a surgeon must complete to gain proficiency at a procedure, at which point further training would not lead to any more improvement in technique or outcome. As the popularity of robotic surgery increases there is an increased emphasis on how to best translate traditional operative teaching to the realm of robotic surgery in order to lessen the burden of this learning curve. The use of surgical simulators, dual console systems, and mentor programs have all been implemented to help overcome steep aspects of the learning curve. Large series have demonstrate improved surgical and oncologic outcomes than smaller reports, which is indicative of a learning curve. However, without standardization, cutoffs to define what that learning curve is cannot be made

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References

  1. Osborne MP. William Stewart Halsted: his life and contributions to surgery. Lancet Oncol. 2007;8(3):256-265.

    Article  PubMed  Google Scholar 

  2. Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR. Laparoscopic pyeloplasty: the first 100 cases. J Urol. 2002;167(3):1253-1256.

    Article  PubMed  Google Scholar 

  3. Gill IS, Schweizer D, Hobart MG, Sung GT, Klein EA, Novick AC. Retroperitoneal laparoscopic radical nephrectomy: the Cleveland clinic experience. J Urol. 2000;163(6):1665-1670.

    Article  PubMed  CAS  Google Scholar 

  4. Bariol SV, Stewart GD, McNeill SA, Tolley DA. Oncological control following laparoscopic nephroureterectomy: 7-year outcome. J Urol. 2004;172(5 Pt 1):1805-1808.

    Article  PubMed  Google Scholar 

  5. Janetschek G, Daffner P, Peschel R, Bartsch G. Laparoscopic nephron sparing surgery for small renal cell carcinoma. J Urol. 1998;159(4):1152-1155.

    Article  PubMed  CAS  Google Scholar 

  6. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations. Prostate. 1999;39(1):71-75.

    Article  PubMed  CAS  Google Scholar 

  7. Iwamura M, Soh S, Irie A, et al. Laparoscopic pyeloplasty for ureteropelvic junction obstruction: outcome of initial 12 procedures. Int J Urol. 2004;11(7):449-455.

    Article  PubMed  Google Scholar 

  8. Moore RG, Averch TD, Schulam PG, Adams JB 2nd, Chen RN, Kavoussi LR. Laparoscopic pyeloplasty: experience with the initial 30 cases. J Urol. 1997;157(2):459-462.

    Article  PubMed  CAS  Google Scholar 

  9. Pardalidis NP, Papatsoris AG, Kosmaoglou EV. Endoscopic and laparoscopic treatment of ureteropelvic junction obstruction. J Urol. 2002;168(5):1937-1940; discussion 40.

    Article  PubMed  Google Scholar 

  10. Sundaram CP, Grubb RL 3rd, Rehman J, et al. Laparoscopic pyeloplasty for secondary uretero­pelvic junction obstruction. J Urol. 2003;169(6):2037-2040.

    Article  PubMed  Google Scholar 

  11. Schuessler WW, Kavoussi LR, Clayman RV, Vancaille TH. Laparoscopic radical prostatectomy: initial case report [abstract 130]. J Urol. 1992;147:246A.

    Google Scholar 

  12. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997;50(6):854-857.

    Article  PubMed  CAS  Google Scholar 

  13. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000;163(6):1643-1649.

    Article  PubMed  CAS  Google Scholar 

  14. Poulakis V, Ferakis N, Dillenburg W, Vries R, Witzsch U, Becht E. Laparoscopic radical prostatectomy using an extraperitoneal approach: Nordwest hospital technique and initial experience in 255 cases. J Endourol. 2006;20(1):45-53.

    Article  PubMed  Google Scholar 

  15. Paul A, Ploussard G, Nicolaiew N, et al. Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115 procedures. Eur Urol. 2010;57(2):267-272.

    Article  PubMed  Google Scholar 

  16. Lein M, Stibane I, Mansour R, et al. Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies-experience at the Charite Hospital Berlin, Campus Mitte. Eur Urol. 2006;50(6):1278-1282. discussion 83-84.

    Article  PubMed  Google Scholar 

  17. Guillonneau B, Rozet F, Barret E, Cathelineau X, Vallancien G. Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am. 2001;28(1):189-202.

    Article  PubMed  CAS  Google Scholar 

  18. Kavoussi LR. Laparoscopic radical prostatectomy: irrational exuberance? Urology. 2001;58(4):503-505.

    Article  PubMed  CAS  Google Scholar 

  19. Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003;170(5):1738-1741.

    Article  PubMed  Google Scholar 

  20. Menon M, Shrivastava A, Tewari A, et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol. 2002;168(3):945-949.

    Article  PubMed  Google Scholar 

  21. Patel VR, Palmer KJ, Coughlin G, Samavedi S. Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol. 2008;22(10):2299-2305.

    Article  PubMed  Google Scholar 

  22. Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007;110(9):1951-1958.

    Article  PubMed  Google Scholar 

  23. Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007;99(5):1109-1112.

    Article  PubMed  Google Scholar 

  24. Zorn KC, Gofrit ON, Orvieto MA, et al. Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol. 2007;21(11):1341-1344.

    Article  PubMed  Google Scholar 

  25. Murphy DG, Kerger M, Crowe H, Peters JS, Costello AJ. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009;55(6):1358-1366.

    Article  PubMed  Google Scholar 

  26. Joseph JV, Rosenbaum R, Madeb R, Erturk E, Patel HR. Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol. 2006;175(3 pt 1):945-950; discussion 51.

    Article  PubMed  CAS  Google Scholar 

  27. Mottrie A, Van Migem P, De Naeyer G, Schatteman P, Carpentier P, Fonteyne E. Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol. 2007;52(3):746-750.

    Article  PubMed  Google Scholar 

  28. Artibani W, Fracalanza S, Cavalleri S, et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int. 2008;80(3):237-244.

    Article  PubMed  Google Scholar 

  29. Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol. 2006;49(5):866-871.

    Article  PubMed  Google Scholar 

  30. Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol. 2003;44(2):175-181.

    Article  PubMed  Google Scholar 

  31. Raman JD, Dong S, Levinson A, Samadi D, Scherr DS. Robotic radical prostatectomy: operative technique, outcomes, and learning curve. JSLS. 2007;11(1):1-7.

    PubMed  Google Scholar 

  32. Samadi D, Levinson A, Hakimi A, Shabsigh R, Benson MC. From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol. 2007;25(1):105-110.

    Article  PubMed  Google Scholar 

  33. White MA, De Haan AP, Stephens DD, Maatman TK, Maatman TJ. Comparative analysis of surgical margins between radical retropubic prostatectomy and RALP: are patients sacrificed during initiation of robotics program? Urology. 2009;73(3):567-571.

    Article  PubMed  Google Scholar 

  34. Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol. 2002;167(2 pt 1):528-534.

    PubMed  Google Scholar 

  35. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001;28(3):555-565.

    Article  PubMed  CAS  Google Scholar 

  36. Grossfeld GD, Chang JJ, Broering JM, et al. Impact of posi­tive surgical margins on prostate cancer ­recurrence and the use of secondary cancer treatment: data from the CaPSURE database. J Urol. 2000;163(4):1171-1177; quiz 295.

    Article  PubMed  CAS  Google Scholar 

  37. Yossepowitch O, Bjartell A, Eastham JA, et al. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol. 2009;55(1):87-99.

    Article  PubMed  Google Scholar 

  38. Blute ML, Bostwick DG, Bergstralh EJ, et al. Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology. 1997;50(5):733-739.

    Article  PubMed  CAS  Google Scholar 

  39. Eastham JA, Kuroiwa K, Ohori M, et al. Prognostic significance of location of positive margins in radical prostatectomy specimens. Urology. 2007;70(5):965-969.

    Article  PubMed  Google Scholar 

  40. Cheng L, Darson MF, Bergstralh EJ, Slezak J, Myers RP, Bostwick DG. Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer. 1999;86(9):1775-1782.

    Article  PubMed  CAS  Google Scholar 

  41. Catalona WJ, Smith DS. 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol. 1994;152(5 pt 2):1837-1842.

    PubMed  CAS  Google Scholar 

  42. Sofer M, Hamilton-Nelson KL, Schlesselman JJ, Soloway MS. Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy. J Clin Oncol. 2002;20(7):1853-1858.

    Article  PubMed  Google Scholar 

  43. Herrell SD, Smith JA Jr. Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology. 2005;66(5 suppl):105-107.

    Article  PubMed  Google Scholar 

  44. Zorn KC, Orvieto MA, Gong EM, et al. Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol. 2007;21(4):441-447.

    Article  PubMed  Google Scholar 

  45. Murphy DG, Hall R, Tong R, Goel R, Costello AJ. Robotic technology in surgery: current status in 2008. ANZ J Surg. 2008;78(12):1076-1081.

    Article  PubMed  Google Scholar 

  46. Salomon L, Anastasiadis AG, Katz R, et al. Urinary continence and erectile function: a prospective evaluation of functional results after radical laparoscopic prostatectomy. Eur Urol. 2002;42(4):338-343.

    Article  PubMed  Google Scholar 

  47. Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A. Potency following robotic ­radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol. 2005;174(6):2291-2296; discussion 6.

    Article  PubMed  Google Scholar 

  48. Savera AT, Kaul S, Badani K, Stark AT, Shah NL, Menon M. Robotic radical prostatectomy with the “Veil of Aphrodite” technique: histologic evidence of enhanced nerve sparing. Eur Urol. 2006;49(6):1065-1073; discussion 73-74.

    Article  PubMed  Google Scholar 

  49. Chabert CC, Merrilees DA, Neill MG, Eden CG. Curtain dissection of the lateral prostatic fascia and potency after laparoscopic radical prostatectomy: a veil of mystery. BJU Int. 2008;101(10):1285-1288.

    Article  PubMed  Google Scholar 

  50. Ahlering TE, Eichel L, Skarecky D. Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy. Urology. 2008;72(6):1371-1374.

    Article  PubMed  Google Scholar 

  51. Narazaki K, Oleynikov D, Stergiou N. Robotic surgery training and performance: identifying objective variables for quantifying the extent of proficiency. Surg Endosc. 2006;20(1):96-103.

    Article  PubMed  CAS  Google Scholar 

  52. Judkins TN, Oleynikov D, Stergiou N. Objective evaluation of expert and novice performance during robotic surgical training tasks. Surg Endosc. 2009;23(3):590-597.

    Article  PubMed  Google Scholar 

  53. Katsavelis D, Siu KC, Brown-Clerk B, et al. Validated robotic laparoscopic surgical training in a virtual-reality environment. Surg Endosc. 2009;23(1):66-73.

    Article  PubMed  Google Scholar 

  54. Scott DJ, Bergen PC, Rege RV, et al. Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg. 2000;191(3):272-283.

    Article  PubMed  CAS  Google Scholar 

  55. Rashid HH, Leung YY, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology. 2006;68(1):75-79.

    Article  PubMed  Google Scholar 

  56. Schroeck FR, de Sousa CA, Kalman RA, et al. Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate. Urology. 2008;71(4):597-601.

    Article  PubMed  Google Scholar 

  57. Fabrizio MD, Tuerk I, Schellhammer PF. Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. J Urol. 2003;169(6):2063-2065.

    Article  PubMed  Google Scholar 

  58. Zorn KC, Gautam G, Shalhav AL, et al. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol. 2009;182(3):1126-1132.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, Columbia University Medical Center, New York, NY, USA

    Trushar Patel M.D.

  2. Department of Urology, Columbia University, New York, NY, USA

    Ketan K. Badani M.D.

Authors
  1. Trushar Patel M.D.
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  2. Ketan K. Badani M.D.
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Editors and Affiliations

  1. Florida Hospital Celebration Health, Global Robotics Institute, Celebration Place 410, Celebration, 34747, Florida, USA

    Vipul R. Patel

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© 2011 Springer-Verlag London Limited

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Patel, T., Badani, K.K. (2011). Examining the Learning Curve of Robotic Surgery. In: Patel, V. (eds) Robotic Urologic Surgery. Springer, London. https://doi.org/10.1007/978-1-84882-800-1_9

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  • DOI: https://doi.org/10.1007/978-1-84882-800-1_9

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  • Online ISBN: 978-1-84882-800-1

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