RARP Checklist for Early Career Efficiency and Troubleshooting Skills

How to cite: Davis JW. RARP Checklist for Early Career Efficiency and Troubleshooting Skills. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/rarp-checklist-for-early-career-efficiency-and-troubleshooting-skills/

Summary

John W. Davis, MD, FACS, Professor of Urology and Director, Urosurgical Prostate Program, University of Texas MD Anderson Cancer Center, Houston, Texas, presents a practical framework for early-career surgeons developing expertise in robotic-assisted radical prostatectomy (RARP), emphasizing that surgical efficiency and troubleshooting skills extend beyond technical execution and require structured decision making, multidisciplinary learning, and familiarity with evolving robotic approaches.

Dr. Davis begins by encouraging early-career surgeons to adopt an integrative model of prostate cancer care that incorporates multidisciplinary collaboration with radiation oncology, medical oncology, pathology, and imaging specialists. Participation in tumor boards, guideline development, clinical trials, and peer review is essential for developing clinical judgment that extends beyond operative technique. Social media discussion forums are also considered a potential source of peer consultation for uncommon clinical scenarios, though professional conduct and the interpretation of commentary remain important considerations.

Dr. Davis outlines key decision points in planning robotic radical prostatectomy. These include evaluation of lymph node risk and decisions regarding extended pelvic lymph node dissection, assessment of extraprostatic extension risk using imaging and biopsy findings, tumor location, prostate size, and the presence of prior pelvic or abdominal surgery. Patient-specific factors such as body mass index, prior transurethral prostate surgery, median lobe anatomy, implanted prosthetic reservoirs, and kidney transplantation history may also influence surgical planning.

Dr. Davis reviews common operative approaches, including traditional transperitoneal access, extraperitoneal approaches, and emerging single-port robotic platforms. Each technique has advantages and limitations related to operative exposure, bleeding risk, technical complexity, and learning curve.

Practical troubleshooting strategies are discussed for managing difficult operative scenarios, including prior abdominal surgery, intra-abdominal adhesions, large prostate glands, and challenging patient body habitus. Alternative access strategies, including extraperitoneal and transvesical robotic approaches, may provide solutions in selected cases.

Dr. Davis emphasizes that while most anatomic challenges can be managed with experience and training, disease extent remains a key determinant of treatment selection. Modern imaging, such as prostate-specific membrane antigen positron emission tomography, may identify nodal disease that changes management decisions and patient selection for surgery.

The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 36 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.

The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts.