在大容量机器人手术中心经过培训计划后安全引入机器人辅助根治性前列腺切除术。
Safe introduction of robot-assisted radical prostatectomy after a training program in a high-volume robotic centre.
作者信息
Lumen Nicolaas, Van Praet Charles, De Troyer Bart, Fonteyne Valérie, Oosterlinck Willem, Decaestecker Karel, Mottrie Alexandre
机构信息
Department of Urology, Ghent University Hospital, Ghent, Belgium.
出版信息
Urol Int. 2013;91(2):145-52. doi: 10.1159/000350652. Epub 2013 Jul 11.
INTRODUCTION
Localized prostate cancer is increasingly treated by robot-assisted radical prostatectomy (RARP). We evaluated the introduction of RARP following a training program at a high-volume robotic center.
MATERIALS AND METHODS
Before starting RARP, a young urologist followed a 6-month training program. The outcome of his first 50 RARPs was compared with the last 50 open radical prostatectomies (ORPs) performed by an experienced urologist at the same institution. Tumor characteristics were similar in both groups. Median follow-up was 12 (RARP) and 31 (ORP) months (p < 0.001).
RESULTS
RARP was associated with more nerve sparing (82 vs. ORP 46%, p < 0.001), longer operation time [median 205 (range 120-310) vs. ORP 180 (85-280) min, p = 0.001], lower decline of postoperative hemoglobin [RARP -2.1 (0.1-4.5) vs. ORP -4.0 (1.0-7.0) g/dl, p < 0.001] and shorter catheter stay [6 (5-47) vs. ORP 14 (9-43) days, p < 0.001]. Complication rates were similar. Overall and pT2-positive surgical margin rate was 8 vs. 24% (p = 0.054) and 0 vs. 11.8% (p = 0.114) for RARP vs. ORP, respectively. One-year urinary continence rate was 76.7 (RARP) and 75.8% (ORP, p = 0.833).
CONCLUSIONS
RARP was safely introduced after a training program in a high-volume robotic center, both surgically, oncologically and functionally.
引言
局限性前列腺癌越来越多地通过机器人辅助根治性前列腺切除术（RARP）进行治疗。我们评估了在一家大型机器人手术中心经过培训后开展RARP的情况。
材料与方法
在开始RARP之前，一名年轻的泌尿科医生参加了为期6个月的培训项目。将他最初的50例RARP手术结果与同机构一名经验丰富的泌尿科医生进行的最后50例开放性根治性前列腺切除术（ORP）结果进行比较。两组的肿瘤特征相似。RARP组的中位随访时间为12个月，ORP组为31个月（p<0.001）。
结果
RARP手术保留神经的比例更高（82%对ORP的46%，p<0.001），手术时间更长[中位时间205（范围120 - 310）分钟对ORP的180（85 - 280）分钟，p = 0.001]，术后血红蛋白下降幅度更低[RARP组为-2.1（0.1 - 4.5）对ORP组为-4.0（1.0 - 7.0）g/dl，p<0.001]，导尿管留置时间更短[6（5 - 47）天对ORP组的14（9 - 43）天，p<0.001]。并发症发生率相似。RARP组与ORP组的总体手术切缘阳性率和pT2期手术切缘阳性率分别为8%对24%（p = 0.054）和0对11.8%（p = 0.114）。一年尿控率RARP组为76.7%，ORP组为75.8%（p = 0.833）。
结论
在一家大型机器人手术中心经过培训后，RARP在手术、肿瘤学和功能方面都得以安全开展。
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