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M SUMITOMO ET AL.
Original Article: Clinical Investigation Editorial Comment Editorial Comment from Mr Skarecky to Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload In the past decade of robotic-assisted radical prostatectomy, the learning curve has transcended from simply the time to attain a 4-h surgery to establishing superior oncological outcomes without sacrificing quality of life (QOL) outcomes; that is, urinary continence and potency. Preservation of sexual function QOL is technically difficult in the early learning curve, perhaps requiring scores of cases to achieve the results cited in the literature. Unfortunately, potent and erectile dysfunctional men are still included in early cases, and then are left with unsuccessful potency outcomes.1,2 When patients consent to be in the learning curve, the implicit agreement is best care in exchange for surgeon experience. The literature suggests high expectations for men undergoing “innovative” robotic-assisted radical prostatectomy, and found greater dissatisfaction, when expected outcomes and QOL are not met.3 Sexual function in the learning curve can be improved by several methods. First, as in oncology, careful patient selection of impotent men (International Index of Erectile Function (IIEF)-5 score
M SUMITOMO ET AL.
Original Article: Clinical Investigation Editorial Comment Editorial Comment from Mr Skarecky to Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload In the past decade of robotic-assisted radical prostatectomy, the learning curve has transcended from simply the time to attain a 4-h surgery to establishing superior oncological outcomes without sacrificing quality of life (QOL) outcomes; that is, urinary continence and potency. Preservation of sexual function QOL is technically difficult in the early learning curve, perhaps requiring scores of cases to achieve the results cited in the literature. Unfortunately, potent and erectile dysfunctional men are still included in early cases, and then are left with unsuccessful potency outcomes.1,2 When patients consent to be in the learning curve, the implicit agreement is best care in exchange for surgeon experience. The literature suggests high expectations for men undergoing “innovative” robotic-assisted radical prostatectomy, and found greater dissatisfaction, when expected outcomes and QOL are not met.3 Sexual function in the learning curve can be improved by several methods. First, as in oncology, careful patient selection of impotent men (International Index of Erectile Function (IIEF)-5 score
