Wijburg Carl J, Hannink Gerjon, Michels Charlotte T J, Weijerman Philip C, Issa Rami, Tay Andrea, Decaestecker Karel, Wiklund Peter, Hosseini Abolfazl, Sridhar Ashwin, Kelly John, d'Hondt Frederiek, Mottrie Alexandre, Klaver Sjoerd, Edeling Sebastian, Dell'Oglio Paolo, Montorsi Francesco, Rovers Maroeska M, Witjes J Alfred
Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur Urol Open Sci. 2022 Apr 2;39:55-61. doi: 10.1016/j.euros.2022.03.004. eCollection 2022 May.
The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure.
To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall complications (OC90, Clavien-Dindo grades 1-5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS).
This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with ≥100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion.
Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS.
A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80-193) and 97 cases (95% CI 41-154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7-21%). The plateau level was reached after 75 cases (95% CI 65-86) for OT, 88 cases (95% CI 70-106) for EBL, and 198 cases (95% CI 130-266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres.
This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate.
We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications.
近年来，机器人辅助根治性膀胱切除术联合体内重建术（iRARC）的应用有所增加。对于该手术的学习曲线长度，人们了解甚少。
从90天内的严重并发症（MC90；Clavien-Dindo分级≥3级）、90天内的总体并发症（OC90，Clavien-Dindo分级1-5级）、手术时间（OT）、估计失血量（EBL）和住院时间（LOS）方面研究iRARC的学习曲线长度。
设计、设置和参与者：这是一项对来自9家欧洲高容量医院（病例数≥100例）的所有连续iRARC病例的回顾性分析。所有患者均患有膀胱癌并接受了iRARC手术，采用回肠导管或新膀胱进行尿流改道。
在MC90、OC90、OT、EBL和LOS的两段混合效应模型中，用于代表学习曲线长度的结果参数是达到平台期所需的连续病例数。
纳入了2003年至2018年间接受iRARC手术的2186例患者。MC90和OC90分别在137例（95%置信区间[CI]80-193）和97例（95%CI 41-154）后达到平台期。平台期的平均MC90发生率为14%（95%CI 7-21%）。OT在75例（95%CI 65-86）后达到平台期，EBL在88例（95%CI 70-106）后达到平台期，LOS在198例（95%CI 130-266）后达到平台期。该研究的一个主要局限性是各中心之间尿流改道类型的平衡存在差异。
这项对9个欧洲中心的iRARC学习曲线进行的多中心回顾性分析表明，需要连续137例病例才能达到稳定的MC90发生率。
我们对膀胱癌患者机器人辅助膀胱切除及膀胱重建的手术学习曲线进行了多中心分析。我们发现需要连续137例病例才能达到严重并发症的稳定发生率。
