Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore.
Department of Urology and Urological Science Institute, Severance Hospital, Yongsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Updates Surg. 2021 Jun;73(3):1189-1196. doi: 10.1007/s13304-021-01028-0. Epub 2021 Apr 23.
Proctoring may facilitate a safe transition to robotic-assisted partial nephrectomy (RAPN) for centres performing open (OPN) and laparoscopic partial nephrectomies (LPN). This study compared the 5-year outcomes of RAPN, initiated with a team-based proctorship, with OPN and LPN. Following an observation course at the proctor's institution and a 3-surgeon performance of proctored RAPN in August 2014, a review of 90 RAPN, 29 LPN and 43 OPN consecutively performed by the same team from 2013 to 2019 at National University Hospital, Singapore was conducted. Peri-operative data, functional and oncological outcomes were compared amongst the three groups. Most cases were performed robotically after 2015 with comparable baseline characteristics in all groups. Median RENAL Nephrometry Score was not significantly different between RAPN (8 [IQR 6, 9]) and OPN (9 [IQR 7, 10]) (P = 0.12) but was significantly lower for LPN (7 [IQR 5, 8]) compared to RAPN (P = 0.002). RAPN achieved the lowest blood loss (226 ml vs.348 ml and 263 ml for OPN and LPN respectively, P = 0.02), transfusion rate (3% vs.21% and 17% respectively, P = 0.003) and median length of stay after surgery (4 vs.6 and 5 days respectively, P = 0.001). Complication rates, warm ischemic times were similar between the three approaches with no differences in 1-year and long-term renal function. The rate of positive surgical margin was 8%, 8% and 3% for RAPN, LPN and OPN, respectively (P = 0.76), with a single recurrence in each arm. Despite modest hospital volume, a team-based proctorship facilitated the transition to the Da Vinci robotic platform to perform partial nephrectomies of equivalent complexities as open surgery, achieving improved perioperative outcomes, while maintaining oncological and kidney functional results.
带教可能有助于中心从开放（OPN）和腹腔镜部分肾切除术（LPN）过渡到安全的机器人辅助部分肾切除术（RAPN）。这项研究比较了 RAPN 的 5 年结果，RAPN 最初是由团队式带教进行的，与 OPN 和 LPN 进行了比较。在 2014 年 8 月在带教机构进行了观察课程并由 3 名外科医生进行了带教的 RAPN 后，对 2013 年至 2019 年期间由同一团队在新加坡国立大学医院连续进行的 90 例 RAPN、29 例 LPN 和 43 例 OPN 进行了回顾性分析。比较了三组的围手术期数据、功能和肿瘤学结果。大多数病例在 2015 年后都是通过机器人完成的，所有组的基线特征都相似。RAPN 的中位 RENAL 肾切除术评分（8 [IQR 6, 9]）与 OPN（9 [IQR 7, 10]）之间无显著差异（P=0.12），但与 RAPN 相比，LPN（7 [IQR 5, 8]）显著降低（P=0.002）。RAPN 的出血量最低（226 ml 与 OPN 的 348 ml 和 LPN 的 263 ml 相比，P=0.02）、输血率（3%与 OPN 的 21%和 LPN 的 17%相比，P=0.003）和术后中位住院时间（4 天与 OPN 的 6 天和 LPN 的 5 天相比，P=0.001）。三种方法的并发症发生率和热缺血时间相似，1 年和长期肾功能无差异。RAPN、LPN 和 OPN 的阳性切缘率分别为 8%、8%和 3%（P=0.76），每个组都有一次复发。尽管医院的工作量不大，但团队式带教有助于过渡到达芬奇机器人平台，以执行与开放手术相当复杂的部分肾切除术，实现了更好的围手术期结果，同时保持了肿瘤学和肾脏功能的结果。
