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Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review

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Abstract

Purpose

To perform a systematic search and review of the available literature on the learning curves (LCs) in laparoscopic and robot-assisted prostate surgery.

Methods

Medline was systematically searched from 1946 to January 2021 to detect all studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, reporting on the LC in laparoscopic radical prostatectomy (LRP), laparoscopic simple prostatectomy (LSP), robot-assisted radical prostatectomy (RARP) and robot-assisted simple prostatectomy (RSP).

Results

In total, 47 studies were included for qualitative synthesis evaluating a single technique (LRP, RARP, LSP, RSP; 45 studies) or two techniques (LRP and RARP; 2 studies). All studies evaluated outcomes on real patients. RARP was the most widely investigated technique (30 studies), followed by LRP (17 studies), LSP (1 study), and RSP (1 study). In LRP, the reported LC based on operative time; estimated blood loss; length of hospital stay; positive surgical margin; biochemical recurrence; overall complication rate; and urinary continence rate ranged 40–250, 80–250, 58–200, 50–350, 110–350, 55–250, 70–350 cases, respectively. In RARP, the corresponding ranges were 16–300, 20–300, 25–200, 50–400, 40–100, 20–250, 30–200, while LC for potency rates was 80–90 cases.

Conclusions

The definition of LC for laparoscopic and robot-assisted prostate surgery is not well defined with various metrics used among studies. Nevertheless, LCs appear to be steep and continuous. Implementation of training programs/standardization of the techniques is necessary to improve outcomes.

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  1. Nikolaos Grivas and Ioannis Zachos contributed equally.

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  1. Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece

    Nikolaos Grivas, Georgios Georgiadis, Markos Karavitakis & Charalampos Mamoulakis

  2. Department of Urology, University Hospital of Larissa, University of Thessaly, Medical School, Larissa, Greece

    Ioannis Zachos & Vasilis Tzortzis

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Project development: IZ, VT, CM. Data collection: IZ, NG. Data analysis: IZ, NG, CM. Manuscript writing and approval: all authors.

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Grivas, N., Zachos, I., Georgiadis, G. et al. Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review. World J Urol 40, 929–949 (2022). https://doi.org/10.1007/s00345-021-03815-1

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