Department of Urological Oncology, The Peter MacCallum Cancer Centre, Melbourne, Australia.
Eur Urol. 2010 May;57(5):735-46. doi: 10.1016/j.eururo.2009.12.021. Epub 2009 Dec 28.
Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP.
The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach.
A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper.
RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology.
Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.
机器人辅助腹腔镜根治性前列腺切除术（RALP）使用达芬奇手术系统（美国加利福尼亚州森尼韦尔市直觉外科公司），目前已广泛用于治疗局限性前列腺癌（PCa）。已经发表了许多关于该手术安全性和有效性的报道。然而，关于 RALP 的局限性和并发症的具体报道很少。
本综述的主要目的是通过关注 RALP 的并发症和局限性来确定其不足之处。
对英文文献进行了 Medline 检索，以确定自 2001 年以来发表的所有与 RALP 相关的论文。考虑了提供技术故障、并发症、学习曲线或 RALP 其他不足之处数据的论文。在确定的 412 篇论文中，根据与本文目的的相关性，选择了 68 篇进行综述。
RALP 有以下主要缺点：（1）设备故障发生率为 0.2-0.4%；（2）由于评估技术不标准化，对功能结果的评估并不令人满意；（3）RALP 的总体并发症发生率较低，但使用标准化系统报告并发症时，发生率较高；（4）长期肿瘤学数据和高危 PCa 数据有限；（5）存在陡峭的学习曲线，尽管在<20 例病例中可以达到可接受的手术时间，但在达到平台之前，可能需要>80 例病例的经验才能实现阳性手术切缘（PSM）率；（6）机器人辅助并不能降低与肥胖患者和前列腺较大、中叶或既往手术患者相关的难度，这些患者的结果不如没有这些因素的患者满意；（7）经济障碍阻碍了机器人技术的广泛传播。
本研究中确定的 RALP 的许多缺点可以通过长期数据和更广泛地采用标准化报告措施来解决。不应低估显著的学习曲线，而且该技术的费用仍然限制了许多患者的获得。
