Morgan Monica S C, Shakir Nabeel A, Garcia-Gil Maurilio, Ozayar Asim, Gahan Jeffrey C, Friedlander Justin I, Roehrborn Claus G, Cadeddu Jeffrey A
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA,
World J Urol. 2015 Jun;33(6):781-6. doi: 10.1007/s00345-014-1349-7. Epub 2014 Jun 28.
To compare the outcomes of robotic-assisted laparoscopic prostatectomy (RALP) using a dual versus single-console system in a resident training program using intraoperative, perioperative and postoperative measures.
Patients with PCa who underwent RALP prior to and after implementing a dual-console system at an academic institution were reviewed from 2006-2012. All surgeries were performed by a single-faculty surgeon well after the learning curve was established. In all cases, chief residents participated in the surgery and performed progressively more portions. Demographic, intraoperative and pathologic parameters were obtained. Continence and erectile function were assessed at 6 and 12 months. Postoperative complications were graded using the Clavien-Dindo classification. Predictors of outcomes on univariate analysis were included in multivariate logistic or linear models.
Of 381 patients, 185 and 196 underwent single- or dual-console RALP, respectively. There was a significant decrease in mean operative time using the dual-console system (222 vs. 171 min, p < 0.0001) as well as in the incidence of intraoperative complications (8.65 vs. 1.53%, p < 0.0001) and postoperative complications (14.1 vs. 6.63%, p = 0.03.) Complications of Clavien grade ≥3a occurred more frequently with a single-console system (7 vs. 1%, p = 0.003.) Differences persisted when controlling for potential confounders by multivariate regression. Postoperative measures of continence, erectile function and the rate of biochemical recurrence were similar between cohorts.
When training resident surgeons to perform RALP, a dual-console system may improve intraoperative and perioperative outcomes. The dual-console may represent a safer, more efficient modality for robotic surgical education as compared to a single-console system.
在住院医师培训项目中，采用术中、围手术期及术后指标，比较使用双控制台与单控制台系统进行机器人辅助腹腔镜前列腺切除术（RALP）的效果。
回顾2006年至2012年在一所学术机构实施双控制台系统前后接受RALP的前列腺癌患者。所有手术均由一名教员外科医生在学习曲线确立后进行。所有病例中，总住院医师参与手术并逐步承担更多手术部分。获取人口统计学、术中及病理参数。在6个月和12个月时评估控尿和勃起功能。使用Clavien-Dindo分类法对术后并发症进行分级。单因素分析中结果的预测因素纳入多因素逻辑或线性模型。
381例患者中，分别有185例和196例接受了单控制台或双控制台RALP。使用双控制台系统时，平均手术时间显著缩短（222分钟对171分钟，p<0.0001），术中并发症发生率也显著降低（8.65%对1.53%，p<0.0001），术后并发症发生率也降低（14.1%对6.63%，p=0.03）。Clavien≥3a级并发症在单控制台系统中更频繁发生（7%对1%，p=0.003）。通过多因素回归控制潜在混杂因素后，差异仍然存在。两组间术后控尿、勃起功能及生化复发率的指标相似。
在培训住院医师进行RALP时，双控制台系统可能改善术中及围手术期效果。与单控制台系统相比，双控制台可能是机器人手术教育中更安全、更有效的方式。
