How many cases are needed before you are over the learning curve? Professor Stricker who is now one of the most experienced robotic prostatectomy surgeons in the Southern hemisphere has been invited by “European Urology” to update his cases. Now having done over 1700 cases, which is the most in New South Wales and almost the most in Australia and New Zealand has been invited to update his previous publication on the learning curve of robot radical prostatectomy by one of the major journals in the world “European Urology”. Professor Stricker mentioned that it is critical to have your own outcome data very clearly monitored and done independently. He explained that it probably takes 1000 patients before the learning curve is truly overcome.
The most important areas to monitor in one’s own practice and for that matter in all practices are the following:
- A. The positive margin rate in pT2 disease
- B. The number of cases who undergo radical prostatectomy for Gleason 6 Tumour
- C. Positive margin rate for more locally advanced disease pT3a and b
- D. Significant complications (Clavien 3 and 4)
- E. Sexual outcomes -early and late recovery
- F. Urinary control outcomes – early and late
Professor Stricker has been monitoring these outcomes in his own practice with validated questionnaires since the beginning of his robotic program 11 years ago. He is strongly supporting the initiative by Movember to have a New South Wales registry so that all surgeons can have their “report card” of outcomes. This has already been established in Victoria
Professor Stricker’s current results are:
- A. pT2 positive margin rate 0%
- B. The number of cases who undergo radical prostatectomy for Gleason 6 Tumour 0.6%
- C. Positive margin rate for more locally advanced disease pT3a and b 23%.
- D. Serious complication rate (Clavien 3 and 4 -0.2%) 0.2%
- E. Sexual outcome -(epic questionnaire)-overall rate is 70% of preoperative value
- F. Urinary control rate (epic questionnaire) -6% lower than initial level of continence and 1.5% pad requirement
Professor Stricker said that whilst these are extremely good results, there is always room for improvement particularly on the sexual side. He explained that in his ideal patient such as a person under the age of 55 with good nerve-sparing technique, then he is achieving over 90% success rate in sexual recovery in his series but if one takes all comers then obviously the overall rate is about 70%.