机器人训练对机器人辅助腹腔镜根治性前列腺切除术手术和病理结果的影响。

Impact of robotic training on surgical and pathologic outcomes during robot-assisted laparoscopic radical prostatectomy.

机构信息

Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.

出版信息

Urology. 2010 Aug;76(2):363-8. doi: 10.1016/j.urology.2009.09.085. Epub 2010 Mar 5.

DOI:10.1016/j.urology.2009.09.085

PMID:20206971

Abstract

OBJECTIVES

To prospectively compare outcomes during robotic prostatectomy between surgeons with formal training in either robotic prostatectomy (RALP) or laparoscopic prostatectomy (LRP).

METHODS

A total of 286 robotic prostatectomies were performed by 12 urologists between August 2008 and March 2009 as part of a new robotic surgery program at one of the largest health maintenance organizations in the United States. Four surgeons had formal training in RALP and 8 had formal training in LRP. We prospectively compared surgical and pathologic outcomes between these 2 groups of surgeons.

RESULTS

The 4 RALP surgeons performed 121 RALPs and the 8 LRP surgeons performed 165 RALPs. Patient demographics were similar between groups. The robot-naive group had significantly more clinical stage T1c than the robot-trained group (87.9% vs 74.4%, P = .003). Prostatectomy parameters were similar between the 2 groups of surgeons in terms of prostate size, Gleason score, pathologic stage, and estimated blood loss. The robot-trained surgeons had significantly lower overall positive margin rates (24% vs 34.6%, P = .05) and lower margin rates in T3 tumors (38.5% vs 61.8%, P = .07), which were approximately statistically significant. There was no difference in margin rates in T2 tumors. The robot-trained surgeons had significantly lower apical margin rates (8.3% vs 21.2%, P = .003) and lateral margin rates (1.7% vs 7.3%, P = .05). The robot-trained surgeons had 10%-15% shorter procedure times. There was no difference in complication rates.

CONCLUSIONS

Formal RALP training may be beneficial for surgical and pathologic outcomes of RALP compared with formal LRP training during the initial implementation of a new robotics program.

摘要

目的

前瞻性比较机器人前列腺切除术（RALP）和腹腔镜前列腺切除术（LRP）两种术式的外科医生之间的手术结果。

方法

2008 年 8 月至 2009 年 3 月期间，在美国最大的健康维护组织之一，12 位泌尿科医生开展了 286 例机器人前列腺切除术，作为新机器人手术项目的一部分。其中 4 位外科医生接受了 RALP 的正规培训，8 位外科医生接受了 LRP 的正规培训。我们前瞻性地比较了这两组外科医生的手术和病理结果。

结果

4 位 RALP 外科医生完成了 121 例 RALP，8 位 LRP 外科医生完成了 165 例 RALP。两组患者的人口统计学特征相似。机器人初学者组的临床分期 T1c 明显多于机器人培训组（87.9%比 74.4%，P =.003）。两组外科医生的前列腺切除术参数在前列腺大小、Gleason 评分、病理分期和估计失血量方面相似。机器人培训组的总体阳性切缘率显著较低（24%比 34.6%，P =.05），T3 肿瘤的切缘率也较低（38.5%比 61.8%，P =.07），这两个指标具有统计学意义。T2 肿瘤的切缘率没有差异。机器人培训组的尖部切缘率显著较低（8.3%比 21.2%，P =.003），侧部切缘率也较低（1.7%比 7.3%，P =.05）。机器人培训组的手术时间缩短了 10%-15%。两组的并发症发生率没有差异。