I attended the PACRIM conference Sponsored by the Univ. of California, Irvine in early January. There were several interesting presentations and I plan to post a summary of different ones from time to time. The first in the series is regarding a presentation made by Dr. Randy Fagin from Austin, TX, on “Achieving a Time Efficient Procedure in the Private Practice Setting”. There have been criticisms leveled at robotic prostatectomy stating that it isn’t time efficient compared to open surgery. In our hospital my partner (280+ cases) and I (150+) are completing cases in 2.5 -3 hoursfrom the time the patient is wheeled into the room until he is wheeled out to recovery. That is already competitive with some other surgeons’ times for open radicals. Dr. Fagin is doing even better than we are it would appear.
Results: A total of 250 dVP procedures were completed by a single surgeon in private practice between October 2004 and October 2005. For the first 100 cases and the second 150 cases average incision to band-aid time was 111 and 83 minutes, average console time 78 and 53 minutes, average blood loss 125 ml and 137 ml, and average case turn over time 55 and 30 minutes. Outcomes measures for the total case series yielded up to 90% negative margin rates, up to 90% of men getting down to 2 pads or less per day by 8 weeks post-operatively, up to 65% of men regaining potency capable of intercourse by 6 months.
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He demonstrates what is possible if one is careful about planning, about staff training and about thinking through all your moves in an operation to achieve maximal efficiency. His average blood loss was slightly higher than I would guess ours is and perhaps the shorter times came about at the cost of greater blood loss. But I don’t think the increased amounts involved were significant.