Same Operation, Same Robot, Different Countries: Does it make a Difference?

Objective: To investigate the impact that surgeon and operative room team experience rule in operative time and surgical outcomes. Material and Methods: We retrospectively collected data of 150 robotic radical prostatectomy (RALPs) performed by the same surgeon in two di erent hospitals in di erent periods of his robotic experience. e rst and the last 50 RALPs performed in a dedicated center of robotic surgery at University of Southern California were included respectively in group 1 and group 2. e rst 50 RALPs performed at University Campus Bio-Medico of Rome were included in group 3. In this case, both rst assistant and nursing team were at the beginning of their robotic experience. Monovariate analysis was performed comparing each group in terms of oncological and surgical outcomes. Multivariate logistic regression models were used to assess the risk of positive margin. Results: e mean docking time in group 2 and 3 decreases signi cantly compared to group 1. In group 3 the operative time is signi cant longer. e mean estimated blood loss is higher in group 1 and the number of transfusions decreases in group 2 and 3. e probability to have surgical positive margins increases from pT2a-b-c to pT3b tumor stage. e study is limited because of its retrospective form. Conclusion: Surgeon, assistant, and nurses have a cardinal role in operative and surgical outcomes. Tumor stage is the principle parameter that in uences the oncological outcome. About 50 procedures are required to reach satisfactory operative outcomes although the learning curve continues for hundreds procedures.