Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload

Objectives: To compare perioperative, oncological and functional outcomes of robot-assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload. Methods: Six surgeons carried out robot-assisted radical prostatectomy in 154 patients, which were divided into the following three groups: group1 (n=90), including patients operated on by a surgeon with experience in both open radical prostatectomy and robot-assisted radical prostatectomy; group2 (n=36), including patients operated on by two surgeons with experience in open radical prostatectomy only; and group3 (n=28), including patients operated on by three surgeons with limited experience in both open radical prostatectomy or robot-assisted radical prostatectomy. Results: Groups2 and 3 did not differ significantly in their median values of external blood loss (P=0.165) or console time (P=0.103). Positive surgical margin rates for pT2 patients were also similar in these two groups: 21.2% (7/33) in group 2 and 22.7% (5/22) in group 3 (P=0.894). Kaplan-Meier analysis showed that 12months after robot-assisted radical prostatectomy the prostate-specific antigen-free rate for pT2 patients was 96.0% in group2 and 100% in group3, but the pad-free continence rate was just 91.0% in group1, 88.0% in group2 and 75.5% in group3 (group1 vs group3, P=0.037; group2 vs group3, P=0.239). The major complication rate after robot-assisted radical prostatectomy was 3.3% (3/90) in group1, 11.1% (4/36) in group2 and 17.9% (5/28) in group3 (group1 vs group3, P=0.008; group2 vs group3; P=0.441). Conclusions: Robot-assisted radical prostatectomy offers satisfactory postoperative outcomes even when carried out by surgeons with limited experience in open radical prostatectomy.