Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Urology. 2010 Nov;76(5):1111-6. doi: 10.1016/j.urology.2010.05.010. Epub 2010 Aug 14.
To evaluate the effect of previous robot-assisted radical prostatectomy (RARP) case volume on the outcomes of robot-assisted radical cystectomy. Little is known regarding the effect of previous robotic surgical experience on the implementation and execution of robot-assisted radical cystectomy.
Using the International Robotic Cystectomy Consortium database, 496 patients were identified who had undergone robot-assisted radical cystectomy by 21 surgeons at 14 institutions from 2003 to 2009. The surgeons were divided into 4 groups according to their previous RARP experience (≤ 50, 51-100, 101-150, and > 150 cases). The overall operative time, blood loss, lymph node yield, pathologic stage, and surgical margin status were compared among the 4 groups using chi-square analysis.
The mean operative time was 386 minutes (range 178-827). The mean estimated blood loss was 408 mL (range 25-3500). The operative time and blood loss were both significantly associated with previous RARP experience (P < .001). The mean lymph node count was 17.8 nodes (range 0-68). Lymph node yield and increased pathologic stage were significantly associated with previous RARP experience (P < .001). Finally, 34 (7.0%) of the 482 patients had a positive surgical margin. Margin status was not significantly associated with previous RARP experience (P = .089).
Previous RARP case volume might affect the operative time, blood loss, and lymph node yield at robot-assisted radical cystectomy. In addition, surgeons with increased RARP experience operated on patients with more advanced tumors. Previous RARP experience, however, did not appear to affect the surgical margin status.
评估机器人辅助根治性前列腺切除术（RARP）既往手术例数对机器人辅助根治性膀胱切除术结果的影响。机器人手术经验对机器人辅助根治性膀胱切除术的实施和执行的影响知之甚少。
利用国际机器人膀胱切除术联盟数据库，确定了 496 例患者，这些患者于 2003 年至 2009 年期间，由 14 家机构的 21 名外科医生通过机器人辅助完成根治性膀胱切除术。根据既往 RARP 经验（≤50、51-100、101-150 和>150 例），将外科医生分为 4 组。采用卡方检验比较 4 组之间的总手术时间、出血量、淋巴结产量、病理分期和手术切缘状态。
平均手术时间为 386 分钟（范围 178-827）。平均估计出血量为 408 mL（范围 25-3500）。手术时间和出血量均与既往 RARP 经验显著相关（P<0.001）。平均淋巴结计数为 17.8 个（范围 0-68）。淋巴结产量和增加的病理分期与既往 RARP 经验显著相关（P<0.001）。最后，482 例患者中有 34 例（7.0%）切缘阳性。切缘状态与既往 RARP 经验无显著相关性（P=0.089）。
既往 RARP 病例量可能影响机器人辅助根治性膀胱切除术的手术时间、出血量和淋巴结产量。此外，RARP 经验增加的外科医生为肿瘤进展程度更高的患者进行手术。然而，既往 RARP 经验似乎不会影响手术切缘状态。
