AUA Prostate Cancer review at medscape
An excellent review on the abstracts presented at the AUA was done online at medscape.
It offers 1.5 credits for physicians.
One quote that I thought was interesting was:
These 2 studies taken together indicate that there is a steep learning curve for laparoscopic prostatectomy, even if the robot is used. It is probably medicolegally advisable for a urologist who has performed less than 100 of these cases to inform the patient of this fact. |
I think there is a large variation between surgeons on their learning curve. All surgeons should keep statistics and share them with patients.
I stratify my results by patient number and explain the robotic results to patients.
The important factors are blood loss, hospital stay, surgical margins (marker of cancer control), urinary control, and sexual function.
The only factors that were not as good as open looking at the data retrospectively were surgical times and positive margins. I knew the times would be slower to start, the margins I thought would be as good, but were slightly worse than open.
Blood loss was much less than open on operation 1 and no one has ever had a transfusion.
Hospital stays were better immediately and much better after 25 operations.
Cancer control was as good by operation 26 and better by operation 60.
Urinary control was similar for the first 40 and better after, while getting even better after 80.
Sexual function was slightly better immediately and better after 30, and much better after 60.
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Comments
I, too, found this interesting. One other factor in the learning curve is the interval between cases. As a proctor (instructor) for Intuitive, I help new surgeons to learn the da Vinci robotic Prostatectomy (dVP). Often, a surgeon will do 1 case with longer OR times, and their next case won't be attempted for several months. Meanwhile, they have done a few traditional open prostatectomy surgeries in between. Even if this surgeon (eventually) does 60 or even 100 dVP cases, he/she will likely never be very adept at it if she waits months between each case. Learning and adoption of these challenging robotic surgery skills is exponential with multiple cases in a shorter period of time.
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http://www.DrYew.com
http://www.SanDiegoRoboticProstatectomy.com
Posted by: Jay Yew, M.D. | August 10, 2006 1:01 AM