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The Impact of the Learning Curve on Robot Assisted Pelvic Lymph Node Dissection During Radical Prostatectomy: An Update on the Brown University Experience
George A Turini, III, Simone Thavaseelan, Michael S Lasser, Joseph F Renzulli, II, Gyan Pareek, George E Haleblian
Brown University, Providence, RI
Introduction: Pelvic lymph node dissection (PLND) provides important staging and prognostic information. In 2009, our institution reported on the yield of Robot-Assisted Laparoscopic PLND (RALPLND) in comparison to an age-matched cohort undergoing open PLND. Herein, we assess our continued experience with RALPLND to determine if LN yield has improved as our robotic program has matured.
Materials & Methods: 178 patients underwent radical prostatectomy with PLND between 2006 and 2010. Open PLND was performed in 78 and RALPLND in 100. Data was collected through an IRB approved blinded prospective database by an independent third party committee. Final pathology reports were retrospectively reviewed. Standard template dissection was carried out in both cohorts.
Results: Both cohorts had similar age and Gleason grade (p>0.05). Mean yield for open and RAL PLND were 6.9 and 4.1, respectively (p<0.001). Within the RAL cohort, 3.2 nodes were collected on average in the first 50 cases, compared to 5.5 in the most recent 50 (p<0.001). While there was a significant difference between LN yield of our open cohort and that of the first 50 robotic cases, there was no significant difference when compared to our most recent 50 cases (p=0.114).
Conclusions: We previously published data documenting lower LN yield during RALPLND compared to open PLND. Our current study demonstrates a statistically significant improvement in LN yield as robotic experience is gained. While patients with high-risk disease may benefit from open PLND during a program's early robotic experience, with time, RALPLND can provide LN yields similar to open dissection.
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