Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
Department of Urology, University Hospital of Larissa, University of Thessaly, Medical School, Larissa, Greece.
World J Urol. 2022 Apr;40(4):929-949. doi: 10.1007/s00345-021-03815-1. Epub 2021 Sep 4.
To perform a systematic search and review of the available literature on the learning curves (LCs) in laparoscopic and robot-assisted prostate surgery.
Medline was systematically searched from 1946 to January 2021 to detect all studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, reporting on the LC in laparoscopic radical prostatectomy (LRP), laparoscopic simple prostatectomy (LSP), robot-assisted radical prostatectomy (RARP) and robot-assisted simple prostatectomy (RSP).
In total, 47 studies were included for qualitative synthesis evaluating a single technique (LRP, RARP, LSP, RSP; 45 studies) or two techniques (LRP and RARP; 2 studies). All studies evaluated outcomes on real patients. RARP was the most widely investigated technique (30 studies), followed by LRP (17 studies), LSP (1 study), and RSP (1 study). In LRP, the reported LC based on operative time; estimated blood loss; length of hospital stay; positive surgical margin; biochemical recurrence; overall complication rate; and urinary continence rate ranged 40-250, 80-250, 58-200, 50-350, 110-350, 55-250, 70-350 cases, respectively. In RARP, the corresponding ranges were 16-300, 20-300, 25-200, 50-400, 40-100, 20-250, 30-200, while LC for potency rates was 80-90 cases.
The definition of LC for laparoscopic and robot-assisted prostate surgery is not well defined with various metrics used among studies. Nevertheless, LCs appear to be steep and continuous. Implementation of training programs/standardization of the techniques is necessary to improve outcomes.
对腹腔镜和机器人辅助前列腺手术学习曲线（LC）的现有文献进行系统检索和综述。
系统检索 Medline 数据库，时间从 1946 年至 2021 年 1 月，以符合系统评价和荟萃分析报告的首选条目（PRISMA）声明，报道腹腔镜根治性前列腺切除术（LRP）、腹腔镜单纯前列腺切除术（LSP）、机器人辅助根治性前列腺切除术（RARP）和机器人辅助单纯前列腺切除术（RSP）的 LC。
共纳入 47 项研究进行定性综合评价，评估单一技术（LRP、RARP、LSP、RSP；45 项研究）或两种技术（LRP 和 RARP；2 项研究）。所有研究均评估了真实患者的结果。RARP 是研究最多的技术（30 项研究），其次是 LRP（17 项研究）、LSP（1 项研究）和 RSP（1 项研究）。在 LRP 中，根据手术时间、估计失血量、住院时间、阳性切缘、生化复发、总并发症发生率和尿控率报告的 LC 范围分别为 40-250、80-250、58-200、50-350、110-350、55-250 和 70-350 例。在 RARP 中，相应范围分别为 16-300、20-300、25-200、50-400、40-100、20-250 和 30-200，而 LC 对勃起功能的发生率为 80-90 例。
腹腔镜和机器人辅助前列腺手术 LC 的定义尚未明确，不同研究中使用了各种指标。然而，LC 似乎是陡峭且连续的。需要实施培训计划/技术标准化，以改善结果。
