The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

  • Riccardo Schiavina University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Italy.
  • Marco Borghesi University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Italy.
  • Hussam Dababneh University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy.
  • Martina Sofia Rossi University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy.
  • Cristian Vincenzo Pultrone University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Italy.
  • Valerio Vagnoni University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy.
  • Francesco Chessa | francesco.chessa2@studio.unibo.it University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy.
  • Lorenzo Bianchi University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna, Italy.
  • Angelo Porreca Policlinico Di Abano, Dept. of Urology, Abano Terme, Italy.
  • Alexandre Mottrie OLV Robotic Surgery Institute, Aalst, Belgium.
  • Eugenio Brunocilla University of Bologna, S. Orsola-Malpighi Hospital, Dept. of Urology, Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Italy.

Abstract

Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program.
Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases.
Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases.
Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.

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Published
2018-03-31
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Section
Original Papers - Prostate
Keywords:
Training, Robot assisted radical prostatectomy
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How to Cite
Schiavina, R., Borghesi, M., Dababneh, H., Rossi, M. S., Pultrone, C. V., Vagnoni, V., Chessa, F., Bianchi, L., Porreca, A., Mottrie, A., & Brunocilla, E. (2018). The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy. Archivio Italiano Di Urologia E Andrologia, 90(1), 1-7. https://doi.org/10.4081/aiua.2018.1.1