Department of Urology, St. Vincent's University Hospital, Dublin, Ireland.
Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland.
Ir J Med Sci. 2022 Feb;191(1):479-484. doi: 10.1007/s11845-021-02556-9. Epub 2021 Feb 27.
The learning curve for robotic-assisted radical prostatectomy (RARP) is estimated to be about 50-200 cases. This study will evaluate the benefit of a mentorship programme after completing a mini-fellowship in RARP by an experienced surgeon who previously trained in open and laparoscopic surgery.
Our study was a retrospective comparative analysis of RARP performed by a single consultant urologist. A retrospective chart review of the first 120 cases was performed. The 120 patients were divided into three groups of 40 cases. For the first 40 cases, an appropriately qualified mentor was present. The peri-operative and oncological outcomes were compared between the three groups.
Operative times significantly decreased with experience (250 min vs 234 min vs 225 min, p < 0.05). Complication rates, estimated blood loss, and length of stay were similar between all groups. There was a higher rate of positive margins in the final group (20% vs 17.5% vs 32.5%, p < 0.5). There was a greater number of pT3 tumours in group 3 (42%, n = 17) compared to groups 1 and 2 (20%, n = 8, and 22.5%, n = 9) which may account for the higher rate of positive margins in this group.
In the transition of an experienced laparoscopic surgeon to robotic surgery, we showed that there is a benefit of a mentorship programme after a mini-fellowship in reducing the impact of the learning curve on patient outcomes. Ongoing mentorship may be of benefit in cases where a high volume of tumour is suspected and should be avoided in the early part of the learning curve to maximise oncological outcomes.
机器人辅助根治性前列腺切除术（RARP）的学习曲线估计约为 50-200 例。本研究将评估一位经验丰富的外科医生在完成开放和腹腔镜手术培训后的迷你研究员培训后，通过指导计划获得的益处。
我们的研究是对一位顾问泌尿科医生进行的 RARP 的回顾性比较分析。对前 120 例进行了回顾性图表审查。这 120 名患者分为三组，每组 40 例。对于前 40 例，有一位合格的导师在场。比较了三组之间的围手术期和肿瘤学结果。
手术时间随经验的增加而显著减少（250 分钟比 234 分钟比 225 分钟，p < 0.05）。并发症发生率、估计失血量和住院时间在所有组之间相似。最后一组的阳性边缘率较高（20%比 17.5%比 32.5%，p < 0.5）。第 3 组（42%，n = 17）有更多的 pT3 肿瘤，而第 1 组和第 2 组（20%，n = 8 和 22.5%，n = 9），这可能是该组阳性边缘率较高的原因。
在经验丰富的腹腔镜外科医生向机器人手术过渡的过程中，我们表明迷你研究员培训后的指导计划在减少学习曲线对患者结果的影响方面是有益的。在学习曲线的早期，应该避免在高肿瘤量的情况下进行持续指导，以最大限度地提高肿瘤学结果。
