Mentor training and RALP

P64 MENTOR TRAINING AND RALP Aim of the study The widespread employment of robotic surgery poses a serious concern on how to train surgeons, especially those without any laparoscopic background. To fill the gap many different learning paths are feasible: surgery fellowship and partnership in specialised centers require long training periods, whereas mentor training with skilled surgeons is much easier for new robotic surgeons. The aim of the study is to describe the preliminary experience in different centers with no laparoscopic skills, where robotic surgery started with the support of a mentor. Materials and methods 97 RALP were executed between January 2010 and April 2011 in 3 new robotic centers (73 Milano, 21 Brescia and 6 Pavia). The selection criteria have been: organ-confined disease (T1c-T2), prostate ecographic volume <80 gr, no evidence of third lobe and no need for limphadenectomy following Kattan nomograms. All procedures were performed by skilled laparotomy surgeons, supported by the mentor who followed the first 10 robotic prostatectomies in each center. Surgery was performed with Da Vinci Standard 4 arms in 73 cases and with Da Vinci 4S in 27 cases. The preliminary experience with mentor was evaluated considering operatory time (skin to skin), intraoperatory blood loss, mean stay in hospital, mean permanence of vesical catheter, positive margins and complications (Clavien-Dindo). Results Mean operatory time was 381 minutes (range 195-520) with mean intraoperatory blood loss of 650 ml (range 50-4000) and need for blood transfusion in 9 patients (9.2%). Mean stay in hospital was 6.3 days (range 2-15) with mean permanence of vesical catheter of 10 days (range 5-69). Positive margins were found in 13 out 74 pT2 patients (17.5%) and 9 out of 23 pT3 patients (39.1%). 83 patients did not have any intra- or peri-operatory complications (85.5%), but we registered complications type I in 8 patients, type II in 3 patients, type III in 2 patients and type IV in one patient (myocardial infarction with coronary stenting). Conclusions In the center where the highest number of mentorized RALP was performed, we noticed, after the execution of 30 procedures, a fast and impressive reduction of operatory time, blood loss, hospital stay and catheterisation days. Therefore mentor training seems a good formative training for surgeons approaching robotic procedures.