Department of Urology, University of Washington School of Medicine, 1959 Northeast Pacific St., Seattle, WA 98195, USA.
J Urol. 2011 Jun;185(6 Suppl):2517-22. doi: 10.1016/j.juro.2011.01.021. Epub 2011 Apr 28.
We compared the learning curve and outcomes in children undergoing robotic assisted laparoscopic pyeloplasty during the initiation of a robotic surgery program compared to the benchmark of open pyeloplasty.
The records of our first consecutive 33 children undergoing robotic assisted laparoscopic pyeloplasty from 2006 to 2009 were retrospectively reviewed and compared to those of age and gender matched children who underwent open repair done by senior faculty surgeons before the initiation of our robotic surgery program. We compared operative time, complications, postoperative pain, length of stay and surgical success for 2 surgeons who adopted the robotic approach at an academic teaching institution.
We found no significant differences in length of stay, pain score or surgical success at a median followup of 16 months. The number of complications was similar and they tended to be early and technical in the robotic assisted laparoscopic pyeloplasty group. Overall average operative time was 90 minutes longer (38%) for robotic assisted laparoscopic pyeloplasty (p <0.004). When evaluated chronologically, there was evidence of a learning curve. After 15 to 20 robotic cases overall operative times for robotic assisted laparoscopic cases was consistently within 1 SD of our average open pyeloplasty time with no significant difference in overall operative time (p = 0.23). Of the decrease in overall operative time 70% was due to decreased pyeloplasty time rather than peripheral time.
There was similar safety and efficacy with robotic assisted laparoscopic pyeloplasty, although complications tended to be technical and early in our initial experience. Operative time decreased with experience and after 15 to 20 cases it was similar to that of open pyeloplasty with similar outcomes and surgical success.
我们比较了在机器人手术项目启动期间接受机器人辅助腹腔镜肾盂成形术的儿童与开放肾盂成形术基准相比的学习曲线和结果。
回顾性分析了我们 2006 年至 2009 年期间连续 33 例接受机器人辅助腹腔镜肾盂成形术的儿童的记录，并与在我们机器人手术项目启动之前由资深教员进行的开放修复的年龄和性别匹配的儿童的记录进行了比较。我们比较了在学术教学机构采用机器人方法的 2 名外科医生的手术时间、并发症、术后疼痛、住院时间和手术成功率。
在中位数为 16 个月的随访中，我们发现住院时间、疼痛评分或手术成功率没有显著差异。机器人辅助腹腔镜肾盂成形术组的并发症数量相似，且倾向于早期和技术相关。机器人辅助腹腔镜肾盂成形术的总平均手术时间延长了 90 分钟（38%）（p <0.004）。从时间顺序上评估，存在学习曲线的证据。在进行了 15 至 20 例机器人手术之后，机器人辅助腹腔镜手术的总手术时间始终与我们的平均开放肾盂成形术时间相差 1 个标准差以内，总手术时间没有显著差异（p = 0.23）。总手术时间的减少有 70%是由于肾盂成形术时间的减少，而不是周围时间的减少。
尽管在我们的初步经验中，并发症往往是技术相关和早期的，但机器人辅助腹腔镜肾盂成形术具有相似的安全性和疗效。随着经验的增加，手术时间减少，在进行了 15 至 20 例手术后，手术时间与开放肾盂成形术相似，并且具有相似的结果和手术成功率。
