Impact of Resident Involvement on Robot-Assisted Radical Prostatectomy Outcomes.
OBJECTIVE
This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP).


METHODS
The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases.


RESULTS
Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012.


CONCLUSIONS
Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.
['Schommer|Eric|E|', 'Tonkovich|Kolbi|K|', 'Li|Zhuo|Z|', 'Thiel|David D|DD|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001803:Blood Transfusion D006801:Humans D007396:Internship and Residency D007902:Length of Stay D008297:Male D008875:Middle Aged D059035:Perioperative Period D011468:Prostatectomy D011471:Prostatic Neoplasms D012189:Retrospective Studies D065287:Robotic Surgical Procedures D012669:Seminal Vesicles D000071077:Surgical Oncology D016896:Treatment Outcome D001743:Urinary Bladder D014572:Urology
education prostate robotics