Analysis of Learning Curve in Robot-Assisted Radical Prostatectomy Performed by a Surgeon.

IF 1.8 Q3 UROLOGY & NEPHROLOGY
Advances in Urology Pub Date : 2020-05-26 eCollection Date: 2020-01-01 DOI:10.1155/2020/9191830
Roman I Slusarenco, Konstantin V Mikheev, Artem O Prostomolotov, Roman B Sukhanov, Evgeny A Bezrukov
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引用次数: 8

Abstract

This study aimed to report the learning curve in robot-assisted radical prostatectomy (RARP) performed by one surgeon who is experienced in laparoscopic prostatectomies. The records of 145 RARP cases performed between 2015 and 2017 were evaluated retrospectively. Patients were divided into three groups: group 1 comprised the first 49 cases, group 2 comprised 50-88 cases, and the rest of the cases were assigned to group 3. Continence was defined as the necessity to use at least one pad during a day. Additionally, erectile function recovery was defined as having erection sufficient for sexual intercourse regardless of using a phosphodiesterase type 5 inhibitor. Continence and erectile function recovery were assessed during interviews at 3, 6, and 12 months after surgery. First, all procedures were successfully performed without conversions or blood transfusions. The median follow-up period was 22 months. Moreover, the median skin-to-skin operative time (OT) was 220 minutes. The median blood loss was 150 ml, and the mean hospital stay was 8.9 ± 3.87 days. The median prostate volume was 36 cm³. The overall positive surgical margin rate was 13.1%. Overall, 38 (26.2%) postoperative complications were observed, and 17.9% of them were graded as minor. Anastomotic leakage decreased significantly from group 1 to group 3 (26.5% and 7%, respectively). The continence recovery (0-1 pad) rates were 60.6%, 75.7%, and 84.9% at 3, 6, and 12 months after surgery, respectively. Subsequently, the erectile function recovery rates were 50.9% and 65.4% at 6 and 12 months after surgery, respectively. In conclusion, there are several types of learning curves for RARP. First, the shallowest learning curve was observed for the OT. Regarding the analysis of "advanced learning curve," demonstrating the improvement of OT and blood loss is considered insufficient. Therefore, additional oncological and functional results that require a longer period of investigation are required.

Abstract Image

Abstract Image

机器人辅助根治性前列腺切除术的学习曲线分析。
本研究旨在报告一名具有腹腔镜前列腺切除术经验的外科医生在机器人辅助根治性前列腺切除术(RARP)中的学习曲线。回顾性分析2015 - 2017年收治的145例RARP病例。患者分为三组,第一组49例,第二组50 ~ 88例,其余患者分配到第三组。节制被定义为一天中至少需要使用一个卫生巾。此外,勃起功能恢复被定义为无论使用磷酸二酯酶5型抑制剂,勃起足以进行性交。在术后3、6和12个月的访谈中评估尿失禁和勃起功能恢复情况。首先,所有手术均成功完成,无需转化或输血。中位随访期为22个月。此外,皮肤对皮肤的中位手术时间(OT)为220分钟。中位失血量150 ml,平均住院时间8.9±3.87 d。前列腺中位容积36cm³。手术切缘阳性率为13.1%。总共观察到38例(26.2%)术后并发症,其中17.9%为轻微并发症。吻合口瘘发生率较对照组显著降低(分别为26.5%和7%)。术后3个月、6个月和12个月的尿失禁恢复率分别为60.6%、75.7%和84.9%。术后6个月和12个月勃起功能恢复率分别为50.9%和65.4%。总之,RARP有几种类型的学习曲线。首先,观察到OT的学习曲线最浅。关于“高级学习曲线”的分析,证明OT和失血的改善被认为是不够的。因此,需要更多的肿瘤和功能结果,需要更长的调查时间。
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来源期刊
Advances in Urology
Advances in Urology UROLOGY & NEPHROLOGY-
CiteScore
2.90
自引率
0.00%
发文量
17
审稿时长
15 weeks
期刊介绍: Advances in Urology is a peer-reviewed, open access journal that publishes state-of-the-art reviews and original research papers of wide interest in all fields of urology. The journal strives to provide publication of important manuscripts to the widest possible audience worldwide, without the constraints of expensive, hard-to-access, traditional bound journals. Advances in Urology is designed to improve publication access of both well-established urologic scientists and less well-established writers, by allowing interested scientists worldwide to participate fully.
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