Vol. 45 (6): 1122-1128, November – December, 2019
Haci Ibrahim Cimen 1, Yavuz Tarik Atik 1, Deniz Gul 1, Burak Uysal 1, Mevlana Derya Balbay 2
1 Department of Urology, Training and Research Hospital, Sakarya University, Turkey; 2 Department of Urology, American Hospital, Koc University, Turkey
Introduction: To evaluate the infl uence of previous experience as bed-side assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy.
Materials and Methods: The fi rst 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the fi rst 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the fi rst 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specifi c antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate.
Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was signifi cantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignifi cant.
Conclusion: Our fi ndings might refl ect that previous bedside assistant experience led to an increase in self-confi dence and the ability to manage troubleshooting and made it more likely for surgeons to start with more diffi cult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.
Keywords: Prostatic Neoplasms; Prostatectomy; Robotics