Mavrich Villavicencio H, Esquena S, Palou Redorta J, Gómez Ruíz J J
Servicio de Urología, Fundació Puigvert, Barcelona.
Actas Urol Esp. 2007 Jun;31(6):587-92. doi: 10.1016/s0210-4806(07)73694-x.
We present the first cases of our robotic radical prostatectomy with Da Vinci (RRPdaV) that corresponds to the learning curve (LC) of the surgeon that has initiated with this technique.
We reviewed the first 20 patients that underwent RRPdaV, performed by an expert surgeon, without previous laparoscopic training, but with a wide experience in retropubic and perineal prostatectomy (HV). We analyzed: Surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also: rates and location of surgical margins, as well as functional outcomes with an average follow up of 10 months.
Mean operating time was 140 minutes (100-211) and blood loss 180 mL (80-360), and none required a blood transfusion. There were no intraoperative complications and neither any conversion to open surgery. The only postoperative outstanding fact was mean hospital stay were 3,35 days. (3-5). We had 6 cases of positive surgical margins (30%). The most frequent location was postero-lateral. Eighteen out of 20 patients (90%) were early totally continent, 2 (10%) required the use of one pad during the first six months due slight stress incontinence that stopped spontaneously. From 20 cases, two of them (10%) had preoperative erectile dysfunction; 12 out of the remaining 18 (66.6%) preserved potency at review and 6 (33.4%) had postoperative erectile dysfunction.
It has been demonstrated that robotic surgery for radical prostatectomy is clearly an advantage technique (easy maneuver although it is a minimally invasive technique, comfortable and ergonomic position for the surgeon, 3D visualization and short learning curve). The RRPDAv learning curve is significantly shorter if the surgeon has a wide previous surgical experience in open and/or laparoscopic surgery.
我们展示了首例使用达芬奇机器人进行的根治性前列腺切除术（RRPdaV）病例，这些病例对应于采用该技术的外科医生的学习曲线（LC）。
我们回顾了由一位专家外科医生实施的前20例RRPdaV手术患者，该医生此前没有腹腔镜手术培训经历，但在耻骨后和会阴前列腺切除术（HV）方面经验丰富。我们分析了：手术时间、失血量、转化率、术中和术后并发症、住院时间以及膀胱导尿天数。此外，还分析了手术切缘的比例和位置，以及平均随访10个月后的功能结果。
平均手术时间为140分钟（100 - 211分钟），失血量为180毫升（80 - 360毫升），无一例需要输血。术中无并发症，也无转为开放手术的情况。唯一突出的术后情况是平均住院时间为3.35天（3 - 5天）。我们有6例手术切缘阳性（30%）。最常见的位置是后外侧。20例患者中有18例（90%）早期完全控尿，2例（10%）在最初六个月因轻度压力性尿失禁需要使用一块尿垫，该症状随后自行停止。20例患者中，有2例（10%）术前存在勃起功能障碍；其余18例中有12例（66.6%）在复查时保留了性功能，6例（33.4%）术后出现勃起功能障碍。
已证明机器人辅助根治性前列腺切除术显然是一种优势技术（尽管是微创手术，但操作简便，对外科医生来说体位舒适且符合人体工程学，具有3D可视化效果且学习曲线短）。如果外科医生在开放手术和/或腹腔镜手术方面有丰富的既往手术经验，RRPDAv的学习曲线会显著缩短。
