FROM THE 15TH INTERNATIONAL CONGRESS AND ENDO EXPO 2006, SLS ANNUAL MEETING, BOSTON, MASS, SEPTEMBER 6–9, 2006
RALPH MADEB, DRAGAN GOLIJANIN, CRAIG NICHOLSON, JOY KNOPF, KELLY PICONE, FREDERICK TONETTI, JOHN R. VALVO, LOUIS EICHEL
INTRODUCTION: Several recent studies have suggested that leaders in robotic surgery have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined whether this phenomenon exists among nonfellowship-trained urologists in private practice. Herein, we describe the positive margin rates of 2 nonfellowship-trained private practice urologists who converted from open radical retropubic prostatectomy to robot-assisted laparoscopic radical prostatectomy.
METHODS: The margin positivity data from 2 nonfellowship-trained, private practice urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy from each surgeon were compared with the first 50 and 43 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive surgical margin was defined as a tumor present at the inked margin of the prostate.
RESULTS: A significant decrease occurred in the overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for surgeon 1 dropped from 44% to 20% and from 37% to 5.7%, respectively, after changing from open to robotic prostatectomy. For surgeon 2, the overall positive margin rate changed from 26% to 16% and the pT2 positive margin rate changed from 27.5% to 8% after converting.
CONCLUSION: Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain negative surgical margins. This phenomenon does seem to apply to nonfellowship-trained urologists in private practice and can be realized within the first 50 cases performed.
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