Training of Urologic Oncology Fellows Does Not Adversely Impact Outcomes of Robot-Assisted Laparoscopic Prostatectomy

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Abstract
Purpose: Robot-assisted laparoscopic prostatectomy (RALP) is an increasingly popular treatment choice among men with clinically localized prostate cancer and has resulted in the need to adequately train urologists to perform the procedure. We reviewed the City of Hope experience to determine if the extent of fellow involvement in the procedure has an adverse effect on surgical outcomes. Patients and Methods: We reviewed the charts of 1833 patients who underwent RALP at the City of Hope from January 2004 to September 2007. During the academic year, each fellow has participated in 300 or more RALP with a systematic stepwise approach to learning the operation. The procedure is divided into six segments arranged by the sequence of learning. We examined intraoperative and perioperative outcomes stratified by quartiles of the academic year corresponding to the fellows' progress through the different segments of the operation. Results: No differences were found across quartiles of the academic year for intraoperative or perioperative complications, length of hospital stay, continence rates at 1 year, time to continence, and prostate-specific antigen-free recurrence rates. In the 1st and 3rd quarters of the academic year, from July to September and January to March, there were slightly longer operative times with a mean of 2.9 hours compared with the 2nd and 4th quarter mean of 2.8 hours (P = 0.01). The 3rd quarter also demonstrated slightly higher estimated blood loss of 280 mL compared with the overall mean of 262 mL (P = 0.02). During the 3rd quarter of the year, the fellows are reliably performing bladder neck division, urethral anastomosis, and beginning to learn the dissection of the neurovascular bundles. Conclusions: We found that in a high-volume center for RALP, urologic oncology fellows can be trained to perform the procedure with no significant adverse impact on patient clinical outcomes.