Upper Tract Surgery with the da Vinci - The Learning Curve. Invited lecture - Bristol Urological Institute 19th Annual Scientific Meeting, 28th & 29th November 2012
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Upper Tract Surgery with the da Vinci - The Learning Curve. Invited lecture - Bristol Urological Institute 19th Annual Scientific Meeting, 28th & 29th November 2012
19. Kohol et al, J Am Coll Surg. 2009 Feb;208(2):255-68
Moldovanu et al, JSLS. 2011 Oct-Dec;15(4):533-8
Calatayud et al, Ann Surg. 2010 Jun;251(6):1181-5
22. Patient hospital number Date Consultants case
Step
1 Patient positioning, port
placement, docking
421014 10 Aug 2011 DAG
1385036 16 Aug 2011DAG
1360097 16 Aug 2011 DAG
2037929 8 Sep 2011 DAG
788753 14 Sep 2011 DAG
2 Bladder take down anterior
fat
796467 17 Aug 2011 DAG
530724 8 Sep 2011 DAG
788759 14 Sep 2011 DAG
1114316 19 Sep 2011 EWR
1385039 18 Okt 2011 DAG
3 Division of endopelvic fascia
and DVC
796467 17 Aug 2011 DAG
1365089 23 Aug 2011 DAG
1364939 25 Aug 2011 DAG
How does the learning curve look like? For RALPexperienced open surgeons need at least 8–12 cases to safely perform RALP independently20- 40 RALP to master safely (after 20 similar complication rateswhen compared with100 LRP)However, debate which parameter(s) should be usedas an indicator of learning curves of up to 100 cases for reducing surgical marginsfor LRP: surgical margins in LRP has been shown to plateau at around 200–250 cases [9]for LRP: increasingly lower risk of biochemical recurrence up to the 750th caseAbstract by Sooriakumaran at ASCO 2011:mean OT plateaued after 750 casespositive margins: if pT3 patients were evaluated, the learning curve started to plateau after 1,000-1,500 casesOverall, 1,600 cases to get PSM < 10%
emerged in the early aircraft industry,described by Wright based on the hypothesis that if an operation is repeated, it would take less time to perform. The learning curve was a representation of the number of repetitions needed to decrease the time spent. Wright TP: Factors affecting the cost of airplanes. J Aeronaut Sci 1936; 3: 122.Two Phases: getting comfortable with the equipment and troubleshootinglearning specific skills to be able to safely and proficiently perform a specific surgical procedure
mean pathologic tumour size was 2.8 +/- 1.3 cmpositive surgical margin (PSM) rate of 2%mean creatinine level changed from a baseline value of 1.02 +/- 0.38 mg/dl to 1.1 +/- 0.7 mg/dl 3 mo. after surgery
mean pathologic tumour size 2.8 +/- 1.3 cmpositive surgical margin rate of 2%mean crea level from 1.02 +/- 0.38 mg/dl to 1.1 +/- 0.7 mg/dl 3 mo. after surgery
Prospective 50 patients RA 59 patients LANo difference in morbidity conversion rates, hospital stay
Senior was defined as a surgeon having performed at least 20 traditional unilateral LAS before starting the robotic program.