Artibani Walter, Fracalanza Simonetta, Cavalleri Stefano, Iafrate Massimo, Aragona Maurizio, Novara Giacomo, Gardiman Marina, Ficarra Vincenzo
Department of Oncological and Surgical Sciences, Urology Clinic, Padua, Italy.
Urol Int. 2008;80(3):237-44. doi: 10.1159/000127333. Epub 2008 May 14.
To report our initial experience in the treatment of prostate cancer with robotic-assisted laparoscopic radical prostatectomy (RALP), evaluating our results in terms of learning curve, postoperative outcomes and positive surgical margins.
From April 2005 to February 2006, a single surgeon performed 41 RALP using the da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, Calif., USA). Clinical and pathological data were collected prospectively and analyzed by a researcher from outside our clinic. The main perioperative parameters assessed were the following: operative time, blood loss, transfusion rate, conversion rate, intra- and postoperative complications, hospitalization time, catheterization time, and positive surgical margin rate. To evaluate the learning curve, patients were stratified into three groups: from case 1 to 10 (group 1), from case 11 to 20 (group 2), and from case 21 to 41 (group C).
Median operative time was 210 min. Mean blood loss was 400 ml, with 9.8% of the patients receiving blood transfusions. Conversion to open surgery occurred in 2 cases (4.9%), while 4 postoperative complications (9.7%) were reported. Median times of hospitalization and catheterization were 7 days. Positive surgical margins were detected in 26.8% of the cases (6.9% among pT2 patients). Operative time (p < 0.001), blood loss (p = 0.02), transfusion rate (p = 0.006), and postoperative complication rates (p = 0.03) reduced along the learning curve.
RALP is a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, good results were obtained with regard to postoperative complications and oncological outcome.
报告我们使用机器人辅助腹腔镜根治性前列腺切除术（RALP）治疗前列腺癌的初步经验，从学习曲线、术后结果和手术切缘阳性情况评估我们的结果。
2005年4月至2006年2月，一名外科医生使用达芬奇机器人（美国加利福尼亚州森尼韦尔市直观外科公司）实施了41例RALP。临床和病理数据前瞻性收集，并由我们诊所外的一名研究人员进行分析。评估的主要围手术期参数如下：手术时间、失血量、输血率、转换率、术中和术后并发症、住院时间、导尿时间和手术切缘阳性率。为评估学习曲线，将患者分为三组：病例1至10（第1组）、病例11至20（第2组）、病例21至41（第3组）。
中位手术时间为210分钟。平均失血量为400毫升，9.8%的患者接受输血。2例（4.9%）转为开放手术，报告了4例术后并发症（9.7%）。住院和导尿的中位时间均为7天。26.8%的病例检测到手术切缘阳性（pT2患者中为6.9%）。沿着学习曲线，手术时间（p<0.001）、失血量（p=0.02）、输血率（p=0.006）和术后并发症发生率（p=0.03）均降低。
RALP是一种可行且可重复的技术，学习曲线短，围手术期并发症发生率低。即使在学习曲线的初始阶段，在术后并发症和肿瘤学结果方面也取得了良好的效果。
