Experiences Learned with Institutional Transition from Laparoscopic Radical Prostatectomy (LRP) and Open Radical Prostatectomy (ORP) to da Vinci Prostatectomy (dVP): Perioperative Analysis of Initial Cohort

Adam J. Ball, Kevin P. Bordeau, John W. Davis, Robert W. Given, Donald F. Lynch, B Gambill, Scott G. Hubosky*, Michael D. Fabrizio
Devine-Tidewater Urology, Norfolk, VA

Introduction: Four surgeons from our practice perform radical prostatectomies, and a transition to dVP was initiated in August 2004. We evaluated the perioperative experience of our initial cohort during this transition from both LRP and ORP to dVP.
Methods: Two surgeons (JWD, MDF) transitioned from LRP to dVP. Two surgeons (RWG, DFL) transitioned from radical and perineal prostatectomies to dVP. We reviewed our initial operative experience with dVP. Perioperative data was compiled.
Results: A total of 103 dVPs were surgically attempted (8/04-3/05). Two cases were aborted due to anesthetic complications (1) and disease stage progression (1). Two cases were converted due to difficulties with the anastomosis (1) or the prostatectomy (1). No emergent conversions were necessary. Ninety-nine procedures were successfully completed. Mean operative time (Veress needle to dressing) was 267 minutes (range, 143-368 min). Mean estimated blood loss was 295 ml (range, 50-1500 ml). No significant differences were apparent between the two surgeons performing more than 40 procedures each (258 min [143-355] vs. 268 min [187-368]; 270 ml [50-900] vs. 307 ml [75-1500]). Eight patients underwent pelvic lymphadenectomy. No immediate or delayed rectal injuries were identified. Six patients required prolonged catheterization for urinary leak.
Conclusions: A successful transition to selected performance of dVP has been accomplished by 4 surgeons in one practice in less than 7 months. Experienced surgeons, independent of surgical technique (open or laparoscopic) or fellowship training (oncology and/or endourology), can learn the dVP technique in a timely fashion with adequate surgical mentoring. Prospective follow-up continues.

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