Analysis of the learning curve in robotic-assisted laparoscopic radical prostatectomy in a South African setting

Abstract

Background: Robotic-assisted laparoscopic radical prostatectomy (RALP) represents a modern minimally invasive technique for treating men with localised prostate cancer. The aim of the study is to demonstrate a progression in the learning curve of two South African-based urologists as both embark on their first-ever series of RALP cases. Method: We performed a retrospective audit of patients who had a RALP with two South African urologists between the dates of September 2014 to May 2019. All RALP cases were included unless critical data could not be collected. We analysed several perioperative parameters as surrogates to demonstrate the trend in learning curve. These parameters included: D’Amico risk group classification; console time (CT); estimated blood loss (EBL), length of stay (LOS); and pathological outcomes: T-staging and positive surgical margin (PSM) rates. Results: Our study of 600 RALP cases demonstrates that for the parameters of median CT, EBL, LOS and PSM rates, there were notable improvements between the first and last groups of both surgeons’ series. Conclusion: This study demonstrates that, similar to internationally published data, notable improvements in perioperative outcomes can be observed as each of our two surgeons gain experience in RALP. When analysing our outcomes of CT, EBL, PSM rate and LOS, we see that our results compare favourably to other internationally published data.