Is Presence of a Urology Resident During Robotic Assisted Laparoscopic Radical Prostatectomy Detrimental to Outcomes?
Jacob Baber, MD; Ilene Staff, PhD, Tara McLaughlin, PhD, Joseph Tortora, MS, Joseph Wagner, MD
Hartford Hospital, Hartford, CT
Background: Robotic procedures are an important component of resident training in urology but the impact of resident presence during procedures on outcomes is not known. We analyzed outcomes during and after robotic assisted laparoscopic radical prostatectomy (RALP) on the basis of resident presence or absence during the procedure.
Materials and Methods: We retrospectively reviewed a prospectively maintained database for RALP cases performed between 11/2007 and 12/2016 by a single surgeon on a specific weekday as it was his custom to work with a resident for the first case (R) and without residents (NR) later. Resident console time (i.e., the time that the attending spent instructing the residents) varied on the basis of year of training and skill set. We compared patient characteristics and outcomes for the two groups(R and NR). Outcomes included operative time (OT), robotic time (RT), estimated blood loss (EBL), complications, biochemical recurrence (BCR) (PSA > .2), surgical failure (BCR or early salvage radiotherapy). Self- reported EPIC-26 questionnaires examined continence (no pads or ‘occasional dripping' with 1 security pad/day) and potency (intercourse or erections that were firm enough for intercourse"). We also examined outcome variables on the basis of year of surgery (2007-2011 vs. 2012-2016) as residents have played increasingly greater roles in the procedures over time.
Results: A total of 460 cases (230 NR and 230 R) met inclusion criteria and were included in the analysis. Outcomes from RALP on the basis of R or NR are presented in Table 1. No statistically significant differences were found for any of the pre-operative patient variables, with the exception of higher grade disease (p=0.015). Median follow-up was 30 and 33.5 months for NR and R, respectively (p=0.3). Median OT was significantly longer for R vs. NR (p <0.001) as was RT (p <0.001). No statistically significant differences were observed for any other measure. For the R group, the median OT and median EBL were both significantly greater in the later years relative to the earlier years (2012-2016 vs. 2007-2011; Table 1). No differences were observed in the NR cases for these time periods.
Conclusions: These data suggest that resident console time results in longer operative times. However, the short and long term outcomes from RALP are not compromised.
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