Introduction & Objectives

Since 2005 we have maintained a prospective database of 2087 RALPs from Epworth Eastern private hospital in Victoria. We analysed our database for multiple key performance indicators of surgical outcomes including positive surgical margin (PSM) status and operative times, to produce an analysis of surgical learning curve and early post-operative outcomes.

Materials & Methods

Patient demographics, prostate specific antigen (PSA), clinical stage, operative time, estimated blood loss, length of stay (LOS), early post-operative complications and PSM data was recorded for 2240 RALPs. Complications were classified according to the Clavien classification system.  The mean PSM rate for each case in the series of first 100 for each of eight urologists at our institution was plotted against case number. Statview was used for statistical analysis.

Results

Median patient age, BMI, and pre-operative PSA were 62 years, 27 and 6.1 respectively. Patients had cT1c or T2 stage prostate cancer in 98% (832/847) of cases and Gleason grade 3+3, 3+4 or 4+3 in 48%, 19% and 28% respectively. Median operative time was 195 minutes (105-540 minutes) and estimated blood loss was 350 mLs (50-3500). Blood transfusion rate was 2.5%. 194 complications were identified of which 72%, 23% and 5% were Clavien 1-2, 3 and 4 respectively. Median length of stay (LOS) was 3 days (1-26 days). Overall PSM rate was 18.9%. Rectal injury rate and conversion rate was 0.4%. Statistical analysis of surgical learning curve for 8 combined surgeons demonstrated a reduction in PSM rates out to 100 cases, and that there was no significant difference in area under the curve for between the surgeons.

Conclusion

Overall PSM rate, complication rate and operative outcomes are comparable to similar international published data. RALP learning curve according to PSM extends to 100 cases.