Motoyama Daisuke, Matsushita Yuto, Watanabe Hiromitsu, Tamura Keita, Suzuki Takahisa, Ito Toshiki, Sugiyama Takayuki, Otsuka Atsushi, Miyake Hideaki
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Asian J Endosc Surg. 2020 Jan;13(1):59-64. doi: 10.1111/ases.12683. Epub 2019 Jan 28.
The objective of this study was to evaluate the initial learning curve for robot-assisted partial nephrectomy (RAPN) using the da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, California).
This study included the initial 65 consecutive patients with small renal tumors who had undergone RAPN at our institution. A single trained surgeon with extensive experience in robot-assisted radical prostatectomy, but not in laparoscopic partial nephrectomy, performed RAPN for all patients using the da Vinci Xi. The learning curve was analyzed by examining the perioperative outcomes among five groups each consisting of 13 consecutive patients.
In this series, the median tumor size and R.E.N.A.L. nephrometry score were 23 mm and 7, respectively, and the median console time and warm ischemia time (WIT) were 116 and 15 minutes, respectively. Fifty-eight patients (89.2%) achieved trifecta outcomes, meaning that the ischemic time was ≤25 minutes, there was a negative surgical margin, and no major postoperative complications occurred. Although there were no significant changes in R.E.N.A.L. nephrometry scores over time, increased surgeon experience was significantly associated with a shorter console time and WIT. Drawing logarithmic approximation curves enabled the achievement of a console time ≤150 minutes and WIT ≤20 minutes at the sixth and fourth procedures, respectively. Furthermore, multivariate analysis identified an independent correlation between surgeon experience with WIT, but not with console time.
These findings suggest that regardless of a surgeon's prior experience in laparoscopic partial nephrectomy, an experienced robotic surgeon can perform RAPN using the da Vinci Xi with acceptable perioperative outcomes after a small number of procedures.
本研究的目的是评估使用达芬奇Xi手术系统（直观外科手术公司，加利福尼亚州森尼韦尔市）进行机器人辅助部分肾切除术（RAPN）的初始学习曲线。
本研究纳入了在我们机构连续接受RAPN的最初65例小肾肿瘤患者。由一位在机器人辅助根治性前列腺切除术方面经验丰富但在腹腔镜部分肾切除术方面经验不足的单一训练有素的外科医生，使用达芬奇Xi为所有患者进行RAPN。通过检查每组连续13例患者的围手术期结果来分析学习曲线。
在本系列中，肿瘤大小中位数和R.E.N.A.L.肾计量评分分别为23毫米和7分，控制台时间中位数和热缺血时间（WIT）分别为116分钟和15分钟。58例患者（89.2%）达到了三联成功结果，即缺血时间≤25分钟、手术切缘阴性且未发生重大术后并发症。尽管随着时间推移R.E.N.A.L.肾计量评分没有显著变化，但外科医生经验的增加与较短的控制台时间和WIT显著相关。绘制对数近似曲线显示，在第六次和第四次手术时分别实现了控制台时间≤150分钟和WIT≤20分钟。此外，多变量分析确定外科医生经验与WIT之间存在独立相关性，但与控制台时间无关。
这些发现表明，无论外科医生先前在腹腔镜部分肾切除术方面的经验如何，经验丰富的机器人外科医生在进行少量手术后，使用达芬奇Xi进行RAPN时可获得可接受的围手术期结果。
