Impact of Urology Resident Involvement on Intraoperative, Long-Term Oncologic and Functional Outcomes of Robotic Assisted Laparoscopic Radical Prostatectomy

I am quite certain that every urologic surgeon in a teaching institution has been confronted by a patient stating, "I just want to be sure you are the one doing the surgery". My response to this plea has been to explain the importance of medical teaching, assuring the patient that I am present from start to finish, and that I am the one performing any critical steps that I do not feel the training physician has the skills to perform. Before we completed this study, I would give my patients a handout containing several studies documenting improved outcomes at high volume academic centers, as well as studies demonstrating equivalent short-term outcomes for robotic prostatectomies that involved a teaching component. However, long-term oncologic outcomes were lacking, and I wondered whether or not these results were transferable to my practice.

Not only does this study confirm prior studies demonstrating similar short-term outcomes such as positive margin rates and surgical complication rates, but it also demonstrates equivalent long-term biochemical recurrence rates, potency, and continence for both teaching and nonteaching cases.

Meanwhile, residents continue to pine for more and more surgical autonomy, just as we did when we were residents. I hoped that this study would demonstrate that they may be doing more than they think. Based on our data, I believe they are. Examining our data during different time periods demonstrates increasing resident involvement. Currently, their involvement increases each case by 60 minutes (39%), indicating that they are doing a significant portion of the procedure based on time.

We are hopeful that this study will add to available evidence-based literature that surgeries performed in a teaching setting are safe and efficacious while providing ample teaching to the next generation of surgeons.

Written by: Joseph Wagner, MD, Jacob Baber, MD, Ilene Staff, Ph.D., Tara McLaughlin, Ph.D., Joseph Tortora, MS, Alison Champagne, MPH, Akshay Gangakhedkar, BS, Kevin Pinto, BS, the Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT

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