Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group

Carl J. Wijburg, Gerjon Hannink, Charlotte T.J. Michels, Philip C. Weijerman, Rami Issa, Andrea Tay, Karel Decaestecker, Peter Wiklund, Abolfazl Hosseini, Ashwin Sridhar, John Kelly, Frederiek d'Hondt, Alexandre Mottrie, Sjoerd Klaver, Sebastian Edeling, Paolo Dell'Oglio, Francesco Montorsi, Maroeska M. Rovers, J. Alfred Witjes

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure. Objective: To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall complications (OC90, Clavien-Dindo grades 1–5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). Design, setting, and participants: This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with ≥100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion. Outcome measurements and statistical analysis: Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS. Results and limitations: A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80–193) and 97 cases (95% CI 41–154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7–21%). The plateau level was reached after 75 cases (95% CI 65–86) for OT, 88 cases (95% CI 70–106) for EBL, and 198 cases (95% CI 130–266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres. Conclusions: This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate. Patient summary: We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications.

Original languageEnglish
Pages (from-to)55-61
Number of pages7
JournalEuropean Urology Open Science
Volume39
DOIs
StatePublished - May 2022

Keywords

  • Bladder cancer
  • Complications
  • Intracorporeal
  • Learning curve
  • Radical cystectomy
  • Robot-assisted

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