Robot-assisted laparoscopic prostatectomy: Analysis of an experienced open surgeon's learning curve after 300 procedures

被引：4

作者：

Doumerc N. ^{[1
,4
]}

Yuen C. ^{[1
]}

Savdie R. ^{[2
]}

Rahman M.B. ^{[3
]}

Benito R.P. ^{[2
]}

Stricker P. ^{[1
]}

机构：

[1] Department of Urology, St Vincent's Private Hospital, Sydney, NSW 2010, Suite 905, 438 Victoria Street, Darlinghurst

[2] Cancer Research Program, The Garvan Institute of Medical Research, Sydney, NSW, Darlinghurst

[3] Sydney School of Public Health, The University of Sydney, Sydney, NSW

[4] Service d'Urologie, CHU de Toulouse, Hôpital Rangueil, 31059 Toulouse Cedex 9, 1, Avenue Jean Poulhès

来源：

Journal of Robotic Surgery | 2010年 / 3卷 / 4期

关键词：

Laparoscopy; Learning curve; Prostate cancer; Radical prostatectomy; Robot-assisted laparoscopic prostatectomy;

D O I：

10.1007/s11701-010-0171-5

中图分类号：

学科分类号：

摘要：

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery. From February 2006 to July 2009, 300 patients underwent a robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. This study is a prospective analysis of the baseline patient and tumour characteristics, intraoperative and postoperative data, and histopathologic features. To analyse the RALP learning curve, the joinpoint regression method was used. Mean age of the patient was 61.3 years (range 46-76). Mean pre-operative PSA level was 7 ng/ml (range 0.7-41), and follow-up was 14 months (0.7-41). The mean operating time was 185 min (range 119-525). One hundred and ten cases were required to achieve 3-h proficiency. There were no conversions. The mean hospital stay was 2.8 days (range 2-7). Major complications rate was 1.3%. The blood transfusion rate was 0.6%. The overall positive surgical margin (PSM) rate was 21.3%. pT2 and pT3 PSM rate was 10 and 44%, respectively. The joinpoint regression method showed that the learning curve started to plateau for the overall PSM rate after 205 cases (95% CI 200-249). For pT2 and pT3, PSM rate, the learning curve tended to flatten after 130 and 170 cases, respectively. The analysis of an experienced open surgeon learning curve in transferring his skills to the robotic platform has shown that 3-h proficiency requires 110 cases. The overall, pT2, and pT3 PSM rate take approximately 200, 130, and 170 cases, respectively, to flatten. © Springer-Verlag London Ltd 2010.

引用

页码：229 / 234

页数：5

共 25 条

[1]

Walsh P.C., Donker P.J., Impotence following radical prostatectomy: Insight into etiology and prevention, J Urol, 128, 3, pp. 492-497, (1982)

[2]

Bill-Axelson A., Holmberg L., Ruutu M., Haggman M., Andersson S.O., Bratell S., Spangberg A., Busch C., Nordling S., Garmo H., Et al., Radical prostatectomy versus watchful waiting in early prostate cancer, N Engl J Med, 352, 19, pp. 1977-1984, (2005)

[3]

Pappas T.N., Jacobs D.O., Laparoscopic resection for colon cancer-the end of the beginning?, N Engl J Med, 350, 20, pp. 2091-2092, (2004)

[4]

Patel V.R., Palmer K.J., Coughlin G., Samavedi S., Robot-assisted laparoscopic radical prostatectomy: Perioperative outcomes of 1500 cases, J Endourol, 22, 10, pp. 2299-2305, (2008)

[5]

Rocco B., Gregori A., Stener S., Santoro L., Bozzola A., Galli S., Knez R., Scieri F., Scaburri A., Gaboardi F., Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy, Eur Urol, 51, 4, pp. 996-1003, (2007)

[6]

Dindo D., Demartines N., Clavien P.A., Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey, Ann Surg, 240, 2, pp. 205-213, (2004)

[7]

Kim H.J., Fay M.P., Feuer E.J., Midthune D.N., Permutation tests for joinpoint regression with applications to cancer rates, Stat Med, 19, 3, pp. 335-351, (2000)

[8]

Farnham S.B., Webster T.M., Herrell S.D., Smith Jr. J.A., Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy, Urology, 67, 2, pp. 360-363, (2006)

[9]

Fracalanza S., Ficarra V., Cavalleri S., Galfano A., Novara G., Mangano A., Plebani M., Artibani W., Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study, BJU Int, 101, 9, pp. 1145-1149, (2008)

[10]

Menon M., Tewari A., Baize B., Guillonneau B., Vallancien G., Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: The Vattikuti Urology Institute experience, Urology, 60, 5, pp. 864-868, (2002)

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