Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan.
Surg Endosc. 2021 Aug;35(8):4436-4443. doi: 10.1007/s00464-020-07946-1. Epub 2020 Sep 9.
Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons.
This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors.
Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases.
PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.
自 2000 年达芬奇手术系统问世以来，机器人辅助根治性前列腺切除术（RARP）得到了广泛关注。RARP 现已成为治疗局限性前列腺癌的标准手术方法。然而，尚无研究通过准确测量盆腔内脏脂肪（PVF）体积来检查其手术时间。本研究旨在探讨与机器人辅助根治性前列腺切除术（RARP）外科医生相关的手术时间延长和手术难度的因素。
本研究纳入了 2014 年至 2019 年期间在我院接受 RARP 的 405 例患者。由于解剖学特征被认为会影响 RARP，因此在术前通过 CT 利用 3D 图像分析系统来估计 PVF 和工作空间（WS）。进行单变量和多变量逻辑回归分析，以确定与控制台时间延长相关的因素，如 BMI、前列腺体积、既往腹部手术史、神经保留手术、PVF 和 WS。我们还调查了术后并发症是否与这些因素有关。
更大的 PVF（p=0.028，优势比（OR）为 1.43）、更小的 WS（p<0.001，OR 为 2.48）和神经保留手术（p=0.037，OR 为 1.61）是与控制台时间延长相关的统计学显著因素。此外，更高的 BMI（p=0.013，OR 为 1.49）和更小的骨盆宽度（p<0.001，OR 为 2.63）是与控制台时间延长相关的替代和更实用的因素。吻合口漏发生的概率随危险因素的数量增加而增加，而即使在高危病例中，术后并发症也没有改变。
PVF 和 WS 是 RARP 病例中控制台时间延长的重要因素。然而，BMI 可以像 PVF 一样有用，因为 BMI 与 PVF 显著相关。此外，骨盆宽度（PW）可以替代 WS，因为 PW 与 WS 相关。本研究表明，术前 BMI 和 PW 可能预测手术风险，并确定适合新手外科医生的 RARP 病例。
