PATIENT SAFETY
Experienced bedside-assistants improve operative outcomes
Published on
October 1, 2020
Journal of Robotic Surgery
Overview
Robot-assisted laparoscopic radical prostatectomy (RALP) outcomes may be significantly influenced by the experience of the bedside assistant (BA). A retrospective cohort study examined the surgical outcomes of 170 consecutive RALP cases performed by a single surgeon, comparing those with an experienced BA to those without. The analysis revealed that surgeries with an expert BA were associated with a shorter length of stay (31 hours vs. 42 hours), lower estimated blood loss (296 ml vs. 441 ml), and a reduced positive margin rate (20% vs. 37%). Multivariable analysis confirmed that having an expert BA was a significant predictor of both estimated blood loss and positive margin rates.
These findings suggest that incorporating an experienced bedside assistant during RALP may enhance patient outcomes, particularly during the early learning curve of robotic surgery. By demonstrating the positive impact of expert assistance on critical surgical metrics, this study underscores the importance of the BA's role in optimizing the effectiveness of robotic-assisted procedures.
Results
In total, 170 consecutive cases over three years were analyzed. 111 (65%) were performed without an expert BA. The two groups were not significantly different with regards patient demographics (p > 0.05). On univariate analysis, having an expert BA was associated with a significantly lower LOS (31 h ± 21 vs. 42 h ± 26, p = 0.004), EBL (296 ml ± 180 vs. 441 ml ± 305, p < 0.0001) and positive margin rate (20% vs. 37%, p = 0.03). Other surgical outcomes were comparable between groups. On multivariable analysis, expert BA remained a predictor of, EBL (B stat = - 146, 95% CI - 240 to - 52, p = 0.003) and positive margin rate (OR 0.4, 95% CI 0.2-0.96, p = 0.04).
