Better robotic RP skills linked to better results

Rosalia Viterbo, MDA quasi-randomized trial of open versus robotic radical prostatectomy and an evaluation of robotic inferior vena cava thrombectomy were among other key minimally invasive surgery studies at the AUA annual meeting in Boston. The take-home messages were presented by Rosalia Viterbo, MD, Fox Chase Cancer Center, Philadelphia.

In a randomized trial, robotic cystectomy was associated with shorter length of stay, lower estimated blood loss, and transfusion rates than open cystectomy. Overall surgical margins and lymph node yields were similar in both groups, but increased bladder soft tissue margins and increased operative times were seen for robotic surgeons.

Outcomes generally favored the robotic approach in a quasi-randomized trial of open versus robotic radical prostatectomy (RP), but follow-up was limited to 2 years. There was no difference in biochemical recurrence and margin rates were better for open versus robotic RP in pT2 disease patients, but margin rates favored robotic RP in pT4 patients.

Better robotic RP skills were associated with better results in a MUSIC collaborative study. Surgeons in the highest 25^th percentile skill rating had lower rates of estimated blood loss and fewer catheter replacements than those in the lowest 25^th percentile.

Increased experience in robotic partial nephrectomy by both surgeon and hospital was associated with lower complication rates and shorter length of stay, but in-hospital cost was not significantly affected by provider experience.

Robotic inferior vena cava thrombectomy is challenging, but in tertiary referral centers is feasible, safe, and associated with favorable perioperative outcomes. Encouraging short-term oncologic outcomes were seen.

Laparoscopic adrenalectomy, when possible, should be attempted, as it is faster and results in a shorter length of stay and lower complication rate than the open approach.

Robotic retroperitoneal lymph node dissection for non-seminomatous germ cell tumor in the post-chemotherapy setting is feasible and offers patients the benefits of a minimally invasive approach, but it is technically challenging.

Crowdsourced video ratings may potentially serve as a filter through which lower-performing surgeons are identified for peer review and coaching/teaching initiatives, say authors of a study of robotic RP. Better skills may lead to improved patient care.

The first in-human study of intraoperative anti-prostate-specific membrane antigen fluorescent antibody suggests it may help guide preservation of critical structures during real-time operative procedures.

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