Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group

被引：23

作者：

Wijburg, Carl J. ^{[1
]}

Hannink, Gerjon ^{[2
]}

Michels, Charlotte T. J. ^{[3
]}

Weijerman, Philip C. ^{[1
]}

Issa, Rami ^{[4
]}

Tay, Andrea ^{[4
]}

Decaestecker, Karel ^{[5
]}

Wiklund, Peter ^{[6
]}

Hosseini, Abolfazl ^{[7
]}

Sridhar, Ashwin ^{[8
]}

Kelly, John ^{[8
]}

D'Hondt, Frederiek ^{[9
]}

Mottrie, Alexandre ^{[9
]}

Klaver, Sjoerd ^{[10
]}

Edeling, Sebastian ^{[11
]}

Dell'Oglio, Paolo ^{[12
]}

Montorsi, Francesco ^{[13
]}

Rovers, Maroeska M. ^{[2
,3
]}

Witjes, J. Alfred ^{[14
]}

机构：

[1] Rijnstate Hosp, Dept Urol, Wagnerlaan 55, NL-6815 AD Arnhem, Netherlands

[2] Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Operating Rooms, Med Ctr, Nijmegen, Netherlands

[3] Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Hlth Evidence, Med Ctr, Nijmegen, Netherlands

[4] St Georges Univ Hosp, Dept Urol, London, England

[5] Univ Hosp Gent, Dept Urol, Ghent, Belgium

[6] Mt Sinai Hosp, Dept Urol, New York, NY 10029 USA

[7] Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden

[8] Univ Coll London Hosp, Dept Urol, London, England

[9] Onze Lieve Vrouw Hosp, Dept Urol, Aalst, Belgium

[10] Maasstad Hosp, Dept Urol, Rotterdam, Netherlands

[11] Vinzenz Hosp, Dept Urol, Hannover, Germany

[12] ASST Grande Osped Metropolitano Niguarda, Dept Urol, Milan, Italy

[13] IRCCS Osped San Raffaele, Dept Urol, Div Oncol, Urol Res Inst, Milan, Italy

[14] Radboud Univ Nijmegen, Dept Urol, Med Ctr, Nijmegen, Netherlands

来源：

EUROPEAN UROLOGY OPEN SCIENCE | 2022年 / 39卷

基金：

荷兰研究理事会;

关键词：

Learning curve; Radical cystectomy; Robot-assisted; Bladder cancer; Complications; Intracorporeal; EUROPEAN ASSOCIATION; BLADDER-CANCER; COMPLICATIONS;

D O I：

10.1016/j.euros.2022.03.004

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure.& nbsp;Objective: To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade >= 3), 90-d overall complications (OC90, Clavien-Dindo grades 1-5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS).& nbsp;Design, setting, and participants: This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with >= 100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion.& nbsp;Outcome measurements and statistical analysis: Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS.& nbsp;Results and limitations: A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80-193) and 97 cases (95% CI 41-154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7-21%). The plateau level was reached after 75 cases (95% CI 65-86) for OT, 88 cases (95% CI 70-106) for EBL, and 198 cases (95% CI 130-266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres.& nbsp;Conclusions: This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate.& nbsp;Patient summary: We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications. (C)& nbsp;2022 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology.& nbsp;

引用

页码：55 / 61

页数：7

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