Schommer Eric, Tonkovich Kolbi, Li Zhuo, Thiel David D
1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida.
2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida.
J Endourol. 2016 Oct;30(10):1126-1131. doi: 10.1089/end.2016.0388. Epub 2016 Aug 15.
This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP).
The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases.
Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012.
Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.
本研究探讨住院医师参与机器人辅助根治性前列腺切除术（RARP）各个步骤的围手术期结果。
RARP手术分为七个步骤：膀胱分离（BTD）、盆腔内筋膜、膀胱颈（BN）、精囊/输精管、蒂/神经保留、尖部和吻合。分析了由一名外科医生进行的372例RARP手术。记录住院医师在七个步骤中各自的控制台操作时间。将围手术期变量与仅由外科医生操作的病例进行比较。
在372例病例中，住院医师在控制台操作了232例（62.4%）。仅由外科医生操作的病例与有住院医师参与的病例在估计失血量（p = 0.09）、输血情况（p = 0.11）和并发症（p = 0.33）方面无差异。仅由外科医生操作的病例平均手术室时间（ORT）较短（190.4分钟对206.4分钟，p = 0.003）。比较仅由外科医生操作的病例与有住院医师参与的病例时，切缘阳性情况（p = 0.79）、住院时间（LOS）（p = 0.30）、导尿管留置天数（p = 0.17）、再次入院情况（p = 0.33）或再次手术情况（p = 0.73）均无差异。进行BN步骤的住院医师对BN切缘（p = 0.73）或导尿管留置时间延长（p = 0.62）无影响。如果由住院医师进行BTD，ORT会显著延长（233.0分钟对191.7分钟，p < 0.0001）。进行吻合步骤的住院医师对导尿管留置时间延长（p = 0.62）或LOS（p = 0.20）无影响。在2012年1月购买了Mimic模拟器（Mimic Technologies公司，华盛顿州西雅图）后，住院医师更有可能参与RARP的至少一部分操作。
尽管住院医师在监督下参与RARP控制台操作会延长ORT，且BTD步骤对ORT影响最大，但并不影响围手术期结果。
