Sooriakumaran P, John M, Wiklund P, Lee D, Nilsson A, Tewari A K
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Minerva Urol Nefrol. 2011 Sep;63(3):191-8.
The aim of this study was to define the learning curve for positive surgical margin (PSM) rate and operative time (OT) for robotic assisted laparoscopic radical prostatectomy (RALP); while the learning curve appears shorter for surgical safety for RALP compared to other surgical modalities, this has not been well established for the above parameters.
We performed a retrospective cohort study of 3794 patients who underwent RALP between Jan 2003 and Sep 2009 by three surgeons (DL, PW, AKT) from three centers (UPenn, Karolinska, Cornell). Mean overall PSM rates and mean overall OT were calculated for all three surgeons at intervals of 50 RALPs per surgeon, and learning curves for these means were fit using a loess method. R version 2.71 was used for all statistical analysis.
The learning curve for PSM rates for all patients demonstrated improvements continued with increasing surgeon experience, with over 1600 cases required to get a PSM rate <10%. When pT3 patients were evaluated, the learning curve started to plateau after 1000-1500 cases. Mean OT plateaued after 750 cases though with further surgical experience the OTs started to climb again.
The learning curve for RALP is not as short as previously thought, and a large number of cases are needed to get PSM rates and OTs to a minimum. This suggests that RALP should be performed by high volume surgeons in order to optimize patient outcomes.
本研究旨在确定机器人辅助腹腔镜根治性前列腺切除术（RALP）的切缘阳性（PSM）率和手术时间（OT）的学习曲线；虽然与其他手术方式相比，RALP手术安全性的学习曲线似乎较短，但上述参数的学习曲线尚未得到充分证实。
我们对2003年1月至2009年9月期间在三个中心（宾夕法尼亚大学、卡罗林斯卡学院、康奈尔大学）由三位外科医生（DL、PW、AKT）进行RALP手术的3794例患者进行了回顾性队列研究。以每位外科医生每50例RALP手术为间隔，计算三位外科医生的平均总体PSM率和平均总体OT，并使用局部加权回归散点平滑法（loess方法）拟合这些平均值的学习曲线。所有统计分析均使用R 2.71版本。
所有患者PSM率的学习曲线显示，随着外科医生经验的增加，情况持续改善，需要超过1600例手术才能使PSM率<10%。对pT3期患者进行评估时，学习曲线在1000 - 1500例手术后开始趋于平稳。平均OT在750例手术后趋于平稳，不过随着手术经验的进一步增加，OT又开始上升。
RALP的学习曲线并不像之前认为的那么短，需要大量病例才能将PSM率和OT降至最低。这表明RALP应由经验丰富的外科医生进行，以优化患者的治疗效果。
