PD6-12 SINGLE VERSUS DUAL CONSOLE ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: IMPACT ON INTRAOPERATIVE AND POSTOPERATIVE OUTCOMES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment I1 Apr 2014PD6-12 SINGLE VERSUS DUAL CONSOLE ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: IMPACT ON INTRAOPERATIVE AND POSTOPERATIVE OUTCOMES Maurilio Garcia-Gil, Nabeel Shakir, Monica Morgan, Asim Ozayar, Jeffrey Gahan, Claus Roehrborn, and Jeffrey Cadeddu Maurilio Garcia-GilMaurilio Garcia-Gil More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Monica MorganMonica Morgan More articles by this author , Asim OzayarAsim Ozayar More articles by this author , Jeffrey GahanJeffrey Gahan More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , and Jeffrey CadedduJeffrey Cadeddu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.520AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic prostatectomy (RALP) has increasingly become the standard surgical treatment of prostate cancer (PCa). However, training urologists to perform RALP is challenging as the single console system often requires the observer to view the case in 2 dimensions, hindering assessment of technique. Further, having to switch seats to resume control of the console impedes transfer between surgeons and may result in poorer outcomes. With the introduction of a dual console system, many of these issues have been addressed. We compared the outcomes of a dual versus single console system using intraoperative, perioperative, and postoperative measures. METHODS Patients with biopsy-confirmed PCa who underwent RALP prior to and after implementing a dual-console system were retrospectively reviewed from 2006-2012. All surgeries were performed by a single faculty surgeon at our institution well after the learning curve had been established (>250 cases), with resident participation. Demographic, intraoperative and pathologic parameters for each patient were obtained. Minimum follow-up was 1.5 years. Continence and erectile function were assessed at 6 and 12 months, in pads per day and the International Index of Erectile Function (IIEF) metric respectively. Postoperative complications were graded using the Clavien-Dindo classification. Uni- and multivariate analyses were conducted using the JMP package. RESULTS Of 381 patients identified, 185 and 196 underwent single- or dual-console RALP respectively. There was a significant decrease in operative time using the dual console system (171±44 vs. 222±43 minutes, p<0.0001) as well as in the incidence of intraoperative complications (1.53% vs. 8.65%, p=0.002) and postoperative complications (6.63% vs. 14.1%, p=0.02.) Complications of greater Clavien grade occurred more frequently with a single console system (≥3b: 7.01% vs. 1.02%, p=0.003.) These differences persisted when controlling for age, prostate-specific antigen (PSA) level, Gleason score, and pathologic stage by multivariate logistic regression. No statistical difference was found between the cohorts in other postoperative outcomes including incidence of biochemical recurrence, continence, or IIEF. CONCLUSIONS When training resident surgeons to perform RALP, a dual console system may improve intraoperative and perioperative outcomes and may represent a safer and more efficient modality as compared to a single console system. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e135 Advertisement Copyright & Permissions© 2014Metrics Author Information Maurilio Garcia-Gil More articles by this author Nabeel Shakir More articles by this author Monica Morgan More articles by this author Asim Ozayar More articles by this author Jeffrey Gahan More articles by this author Claus Roehrborn More articles by this author Jeffrey Cadeddu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...