Vasdev Nikhil, Bishop Conrad, Kass-Iliyya Atoine, Hamid Sami, McNicholas Thomas A, Prasad Venkat, Mohan-S Gowrie, Lane Timothy, Boustead Gregory, Adshead James M
Department of UrologyAnaesthetics, Hertfordshire and South Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK.
Anaesthetics, Hertfordshire and South Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK.
Curr Urol. 2013 Feb;7(3):136-44. doi: 10.1159/000356266. Epub 2014 Feb 10.
Robotic radical prostatectomy (RRP) is an established treatment for prostate cancer in selected centres with appropriate expertise. We studied our single-centre experience of developing a RRP service and subsequent training of 2 additional surgeons by the initial surgeon and the introduction of United Kingdom's first nationally accredited robotic fellowship training programme. We assessed the learning curve of the 3 surgeons with regard to peri-operative outcomes and oncological results.
Three hundred consecutive patients underwent RRP between November 2008 and August 2012. Patients were divided into 3 equal groups (Group 1, case 1-100; Group 2, case 101-200; and Group 3, case 201-300). Age, ASA score, preoperative co-morbidities and indications for laparoscopic radical prostatectomy were comparable for all 3 patient groups. Peri-operative and oncological outcomes were compared across all 3 groups to assess the impact of the learning curve for laparoscopic radical prostatectomy. All surgical complications were classified using the Clavien-Dindo system.
The mean age was 60.7 years (range 41-74). There was a significant reduction in the mean console time (p < 0.001), operating time (p < 0.001), mean length of hospital stay (p < 0.001) and duration of catheter (p < 0.001) between the 3 groups as the series progressed. The two most important factors predictive of positive surgical margins (PSM) at RRP were the initial prostate specific antigen (PSA) and tumor stage at diagnosis. The overall PSM rate was 26.7%. For T2/T3 tumors the incidence of PSM reduced as the series progressed (Group 1-22%, Group 2-32% and Group 3-26%). The incidence of major complications i.e. grade Clavien-Dindo system score ≤ III was 2% (6/300).
RRP is a safe procedure with low morbidity. As surgeons progress through the learning curve peri-operative parameters and oncological outcomes improve. This learning curve is not affected by the introduction of a fellowship-training programme. Using a carefully structured mentored approach, RRP can be safely introduced as a new procedure without compromising patient outcomes.
机器人根治性前列腺切除术（RRP）在具备适当专业技能的特定中心已成为前列腺癌的一种既定治疗方法。我们研究了我们单中心开展RRP服务以及由首位外科医生对另外两名外科医生进行后续培训并引入英国首个全国认可的机器人专科培训项目的经验。我们评估了这三位外科医生在围手术期结果和肿瘤学结果方面的学习曲线。
2008年11月至2012年8月期间，连续300例患者接受了RRP手术。患者被分为3个相等的组（第1组，病例1 - 100；第2组，病例101 - 200；第3组，病例201 - 300）。所有3组患者的年龄、美国麻醉医师协会（ASA）评分、术前合并症以及腹腔镜根治性前列腺切除术的指征均具有可比性。比较所有3组的围手术期和肿瘤学结果，以评估腹腔镜根治性前列腺切除术学习曲线的影响。所有手术并发症均使用Clavien - Dindo系统进行分类。
平均年龄为60.7岁（范围41 - 74岁）。随着手术例数的增加，3组之间的平均控制台时间（p < 0.001）、手术时间（p < 0.001）、平均住院时间（p < 0.001）和导尿管留置时间（p < 0.001）均显著减少。RRP时预测手术切缘阳性（PSM）的两个最重要因素是初始前列腺特异性抗原（PSA）和诊断时的肿瘤分期。总体PSM率为26.7%。对于T2/T3期肿瘤，随着手术例数的增加，PSM的发生率降低（第1组 - 22%，第2组 - 32%，第3组 - 26%）。主要并发症（即Clavien - Dindo系统评分≤III级）的发生率为2%（6/300）。
RRP是一种安全的手术，发病率低。随着外科医生度过学习曲线，围手术期参数和肿瘤学结果会得到改善。这种学习曲线不受专科培训项目引入的影响。采用精心构建的带教方法，可以安全地将RRP作为一种新手术引入，而不会影响患者的治疗效果。
