While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes.
Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP).
Design, setting, and participants
We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction.
Our approach to RARP has been described previously. A single-console robotic system was used for all cases.
Outcome measurements and statistical analysis
Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function.
Results and limitations
Greater surgeon experience was associated with better 5-mo sexual function (p
With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement.
Keywords: Learning curve, Sexual function, Robotic, Radical prostatectomy, Nerve-sparing, Neurapraxia.
a Division of Urologic Surgery, Brigham and Women's, Harvard Medical School, Boston, MA, USA
b Center for Surgery and Public Health, Brigham and Women's, Harvard Medical School, Boston, MA, USA
c Department of Urology, Georgetown Medical Center, Washington, DC, USA
d Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
© 2012 European Association of Urology, Published by Elsevier B.V.