Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Tarry 16-703, Chicago, IL, 60611, USA.
University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA.
J Robot Surg. 2010 Jan;3(4):201-7. doi: 10.1007/s11701-009-0162-6. Epub 2009 Nov 19.
Robot-assisted radical prostatectomy (RARP) is a procedure thought to require experience with a significant number of cases before mastering. Most RARP series examine outcomes after the learning curve or by combining results from multiple surgeons. We review a single surgeon's experience during the transition from open radical retropubic prostatectomy (RRP) to RARP using a matched case-control model. We prospectively analyzed 50 RARP cases and made comparison with the last 50 consecutive RRP cases. Operative time was longer for RARP than RRP (341 versus 235 min, p < 0.01), and mean estimated blood loss was less for RARP than RRP (533 versus 1,540 ml, p < 0.01). There was a trend towards fewer positive surgical margins (PSM) for RARP (10%) than RRP (24%; p = 0.06). High-risk patients were found to have a greater percentage of PSM following RRP (70%) in comparison with RARP (17%; p = 0.04). The number of patients who experienced complications was no different between groups (16 versus 12, p = 0.37). Erectile function at 12, 18, and 24 months showed no difference between groups (p = 0.15, 0.92, and 0.23, respectively). There was no difference in continence at 1 year (88.6% versus 89.1%; p = 0.94). During 27.1 months of follow-up for the RARP group and 30.4 months for the RRP group, 92% and 94% of patients had an undetectable prostate-specific antigen (PSA) (defined as ≤0.1), respectively (p = 0.38). We report similar outcomes in patients undergoing RARP by a surgeon transitioning from RRP to RARP, confirming that the learning curve does not affect patient outcomes over a 2-year follow-up.
机器人辅助根治性前列腺切除术（RARP）被认为需要在掌握该技术之前完成大量的病例。大多数 RARP 系列研究都是在学习曲线之后或通过结合多位外科医生的结果来检查手术结果。我们使用匹配的病例对照模型，回顾了一位外科医生从开放根治性耻骨后前列腺切除术（RRP）过渡到 RARP 的经验。我们前瞻性分析了 50 例 RARP 病例，并与最后 50 例连续 RRP 病例进行了比较。RARP 的手术时间长于 RRP（341 分钟比 235 分钟，p<0.01），RARP 的平均估计失血量少于 RRP（533 毫升比 1540 毫升，p<0.01）。RARP 的阳性切缘率（10%）低于 RRP（24%；p=0.06），但差异无统计学意义。高危患者接受 RRP 后的阳性切缘率（70%）高于 RARP（17%；p=0.04）。两组患者的并发症发生率无差异（16 例比 12 例，p=0.37）。两组患者在 12、18 和 24 个月时的勃起功能无差异（p=0.15、0.92 和 0.23）。两组患者在 1 年时的尿控率也无差异（88.6%比 89.1%；p=0.94）。在 RARP 组的 27.1 个月和 RRP 组的 30.4 个月的随访中，分别有 92%和 94%的患者前列腺特异性抗原（PSA）检测不到（定义为≤0.1）（p=0.38）。我们报告了接受由从 RRP 过渡到 RARP 的外科医生进行 RARP 的患者的类似结果，证实学习曲线不会影响患者在 2 年随访期间的结果。
