Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA.
University of Central Florida (UCF), Orlando, Florida, USA.
J Endourol. 2022 Apr;36(4):493-498. doi: 10.1089/end.2021.0656.
Different consoles have been described for the da Vinci single-port (SP) surgery since it was cleared by the FDA in November 2018. However, the literature still lacks studies identifying factors related to the SP learning curve and how to overcome the technological limitations, especially in terms of maintaining acceptable positive surgical margins (PSMs). This study describes our perioperative experience implementing a safe SP approach to radical prostatectomy (RP) while minimizing PSM, especially during the initial learning period. We performed a retrospective analysis of 100 consecutive patients with prostate cancer who underwent RP with the SP robot from June 2019 to December 2020 (IRB 237998). We accessed the perioperative data, pathology report, and short-term oncologic outcomes. We also represented our PSM trends in 100 consecutive cases, discussing potential factors for minimizing the learning curve impact on positive margins and outcomes. Medians and interquartile ranges, as well as frequencies and proportions, were reported for continuous and categorical variables, respectively. The median follow-up is 14 months (8-17). The cohort has a median age of 62 years (56-68), median prostate-specific antigen of 5.5 (4.3-7.7), median preoperative Sexual Health Inventory for Men (SHIM) of 20, median American Urological Association (AUA) of 7 (3-11), and median body mass index of 25.4 (23.4-27.4). The median total operative time was 114 minutes (104-124), the median console time was 80 minutes (75-90). No intraoperative complications were reported. The overall rate of PSMs was 15% (5% were pT2 and 10% were pT3). The SP approach to RP is feasible, safe, and with acceptable intraoperative performance. In this study, we have described crucial factors for considering selection criteria in candidates for SP-robot-assisted RP. We believe that with an appropriate patient selection, this robot can be safely implemented without increasing positive margins and compromising the outcomes, especially during the learning curve period.
自 2018 年 11 月 FDA 批准达芬奇单端口 (SP) 手术以来，已经有不同的控制台被用于该手术。然而，文献中仍然缺乏关于 SP 学习曲线相关因素以及如何克服技术限制的研究，尤其是在保持可接受的阳性手术切缘 (PSM) 方面。本研究描述了我们在实施 SP 根治性前列腺切除术 (RP) 时的围手术期经验，同时尽量减少 PSM，特别是在初始学习阶段。我们对 2019 年 6 月至 2020 年 12 月期间接受 SP 机器人 RP 的 100 例连续前列腺癌患者进行了回顾性分析 (IRB 237998)。我们查阅了围手术期数据、病理报告和短期肿瘤学结果。我们还在 100 例连续病例中展示了我们的 PSM 趋势，讨论了最小化学习曲线对阳性切缘和结果影响的潜在因素。连续变量和分类变量分别用中位数和四分位距以及频率和比例表示。中位随访时间为 14 个月 (8-17)。该队列的中位年龄为 62 岁 (56-68)，中位前列腺特异性抗原为 5.5 (4.3-7.7)，中位术前男性性功能健康调查 (SHIM) 为 20，中位美国泌尿外科学会 (AUA) 为 7 (3-11)，中位体重指数为 25.4 (23.4-27.4)。总手术时间中位数为 114 分钟 (104-124)，控制台时间中位数为 80 分钟 (75-90)。无术中并发症报告。总的 PSM 率为 15% (5%为 pT2，10%为 pT3)。SP 入路 RP 是可行的、安全的，术中表现可接受。在这项研究中，我们描述了在选择 SP-机器人辅助 RP 候选者时考虑选择标准的关键因素。我们相信，通过适当的患者选择，该机器人可以在不增加阳性切缘和影响结果的情况下安全实施，尤其是在学习曲线期间。
