Lebeau Thierry, Rouprêt Morgan, Ferhi Karim, Chartier-Kastler Emmanuel, Bitker Marc-Olivier, Richard François, Vaessen Christophe
Department of Urology of Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris; Faculté de Médecine Pierre et Marie Curie, University Paris VI Paris, France.
Int J Med Robot. 2012 Mar;8(1):67-72. doi: 10.1002/rcs.435.
The robot-assisted laparoscopic approach for radical prostatectomy (RARP) is being performed increasingly worldwide to treat localized prostate cancer (PCa). The aim of this study was to compare the learning curves of two surgeons with different surgical experiences.
A prospective collection of peri-operative data was made: age, body mass index, PSA, clinical stage, biopsy Gleason score, operative time (OT), blood loss (BL), pathological stages, final Gleason scores, and complications. Patients were included, in two groups. The first group comprised the first 100 patients undergoing RARP by an expert laparoscopic surgeon. The second group of 100 patients was operated on by a junior surgeon without robotic console experience. Post-operative complications were defined according to the Clavien grading system for surgical morbidity
For groups 1 and 2 median age was 63 and 62 years, respectively; median pre-operative PSA level was 10 and 8, respectively; the median BMI was 24 and 25, respectively. The median operative time (OT) was 179 and 160 min, respectively (p > 0.05); and median blood loss was 217 and 346 ml, respectively (p = 0.04). The overall transfusion rate was 1.5% and two major complications were recorded in group 1 and four in group 2.
RARP is safe and reproducible even during the initial learning curve. Overcoming the learning curve is multifactorial and is necessarily dependent on the surgeon. However, joining a well-trained team probably affects positively the performance of the surgeon. The value of expert centers to train new surgeons to RARP needs to be evaluated.
机器人辅助腹腔镜根治性前列腺切除术（RARP）在全球范围内越来越多地用于治疗局限性前列腺癌（PCa）。本研究的目的是比较两位具有不同手术经验的外科医生的学习曲线。
前瞻性收集围手术期数据：年龄、体重指数、前列腺特异性抗原（PSA）、临床分期、活检Gleason评分、手术时间（OT）、失血量（BL）、病理分期、最终Gleason评分和并发症。患者分为两组。第一组包括由一位经验丰富的腹腔镜外科医生进行RARP手术的前100例患者。第二组100例患者由一位没有机器人控制台操作经验的初级外科医生进行手术。术后并发症根据Clavien手术并发症分级系统进行定义。
第一组和第二组的中位年龄分别为63岁和62岁；术前PSA水平中位数分别为10和8；中位体重指数分别为24和25。中位手术时间（OT）分别为179分钟和160分钟（p>0.05）；中位失血量分别为217毫升和346毫升（p=0.04）。总体输血率为1.5%，第一组记录了2例严重并发症，第二组记录了4例。
即使在初始学习曲线阶段，RARP也是安全且可重复的。克服学习曲线是多因素的，并且必然取决于外科医生。然而，加入一个训练有素的团队可能会对外科医生的表现产生积极影响。需要评估专家中心对培训新外科医生进行RARP手术的价值。
