机器人手术进修经历对机器人辅助腹腔镜肾部分切除术围手术期结局的影响
Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy.
作者信息
Moriarty Michael A, Nepple Kenneth G, Tracy Chad R, Strigenz Michael E, Lee Daniel K, Brown James A
机构信息
Department of Urology, University of Iowa, Iowa City, Iowa, USA.
出版信息
Curr Urol. 2016 Feb;9(1):19-23. doi: 10.1159/000442845. Epub 2016 Feb 10.
BACKGROUND
We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy.
METHODS
Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20).
RESULTS
Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23).
CONCLUSION
Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.
背景
我们分析了接受机器人手术培训 fellowship 的外科医生与未接受该培训的外科医生在初次进行机器人辅助腹腔镜部分肾切除术时，在患者选择和围手术期结果方面的差异。
方法
分析了每位外科医生的前 10 例病例数据。从两名接受 fellowship 培训的外科医生（n = 20）和两名未接受 fellowship 培训的外科医生（n = 20）中确定了 40 名患者。
结果
接受 fellowship 培训的外科医生所处理的肿块肾测量评分更高（8.0 对 6.0，p = 0.007），且位置更靠后（60% 对 25%，p = 0.03）。腹膜后入路更为常见（50% 对 0%，p = 0.0003）。接受 fellowship 培训的外科医生的热缺血时间有缩短趋势（25.5 对 31.0 分钟，p = 0.08）。围手术期并发症（35% 对 35%，p = 0.45）或最终切缘阳性率（0% 对 15%，p = 0.23）无显著差异。
结论
fellowship 经验可能使外科医生在初始实践中能够处理更具挑战性和位置靠后的肿瘤，并且在进行腹膜后机器人辅助腹腔镜部分肾切除术时明显更得心应手。
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