Dr. Carter Q. Le Profile

Dr. Carter Q. Le

at Mayo Clinic

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Proceedings Article | 23 March 2007 Paper

DaVinci-assisted laparoscopic radical prostatectomy: the learning curve

Carter Le, Khai-Linh Ho, Matthew Gettman

Proceedings Volume 6424, 642412 (2007) https://doi.org/10.1117/12.698787

KEYWORDS: Digital Light Processing, Laparoscopy, Surgery, Robotics, Data conversion, Prostate, Nerve, Brain-machine interfaces, Blood, Statistical analysis

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Objective: To define the learning curve for daVinci-assisted laparoscopic radical prostatectomy (DLP) at our institution. Methods: The data from 170 patients who underwent DLP between August 2002 and December 2004 by a single surgeon (MTG) were reviewed. Operative time, hemoglobin decrease, conversion to open procedure, positive margin rates, complications, length of stay (LOS), length of catheterization, continence, and erectile function were analyzed. Results: Hemoglobin decrease (p=0.11), positive margin rates (p=0.80), and early urinary continence (p=0.17) did not significantly correlate with surgical experience. A trend towards lower complications (p=0.07) and an earlier return of erectile function (p=0.09) was noted with increased experience with DLP. Operative time, hospital stay, catheterization time, and open conversion showed significant association with patient sequence. Median operative time for the first 60 and the last 110 patients was 323.5 and 239.5 minutes (p=<0.0001), respectively. Median LOS for the aforementioned groups was 53 and 51 hours (p=0.009). Length of catheterization declined significantly between the first 60 and the remaining 110 patients, 14 as compared to 11.5 days (p=<0.0001). Eight open conversions occurred, six were in the first 30 patients (p=0.03). Conclusion: As an indicator of the learning curve, the operative time in our series showed no correlation with sequence after the 60^th patient. Thus, despite the advantages of robotics, the learning curve to efficient performance of daVinciassisted laparoscopic radical prostatectomy is long. Oncological and functional outcomes should not be affected during the learning curve.

Proceedings Article | 23 March 2007 Paper

Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients

Carter Le, Khai-Linh Ho, Jeffrey Slezak, Michael Blute, Matthew Gettman

Proceedings Volume 6424, 642411 (2007) https://doi.org/10.1117/12.698786

KEYWORDS: Digital Light Processing, Surgery, Laparoscopy, Prostate cancer, Brain-machine interfaces, Databases, Prostate, Robotics, Holmium, Diagnostics

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Introduction: While the effects of increasing body mass index on prostate cancer epidemiology and surgical approach have recently been studied, its effects on surgical outcomes are less clear. We studied the perioperative outcomes of obese (BMI >= 30) men treated with daVinci-assisted laparoscopic radical prostatectomy (DLP) and compared them to those treated with open radical retropubic prostatectomy (RRP) in a contemporary time frame. Method: After Institutional Review Board approval, we used the Mayo Clinic Radical Prostatectomy database to identify patients who had undergone DLP by a single surgeon and those who had undergone open RRP by a single surgeon between December 2002 and March 2005. Baseline demographics, peri- and post-operative courses, and complications were collected by retrospective chart review, and variables from the two cohorts compared using chi-square method and least-squares method of linear regression where appropriate. Results: 59 patients who had DLP and 76 undergoing RRP were available for study. Baseline demographics were not statistically different between the two cohorts. Although DLP had a significantly lower clinical stage than RRP (p=0.02), pathological stage was not statistically different (p=0.10). Transfusion rates, hospital stay, overall complications, and pathological Gleason were also not significantly different, nor were PSA progression, positive margin rate, or continence at 1 year. After bilateral nerve-sparing, erections suitable for intercourse with or without therapy at 1 year was 88.5% (23/26) for DLP and 61.2% (30/49) for RRP (p=0.01). Follow-up time was similar. Conclusion: For obese patients, DLP appears to have similar perioperative, as well as short-term oncologic and functional outcomes when compared to open RRP.

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