Ambinder David, Wang Shu, Siddiqui Mohummad Minhaj
Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Curr Urol. 2022 Dec;16(4):240-245. doi: 10.1097/CU9.0000000000000119. Epub 2022 Aug 31.
To determine the learning curve (LC) of total operative time and the discrete components of the robotic-assisted radical prostatectomy (RARP) for a recent robotic fellowship-trained urologic surgeon.
We performed a retrospective analysis of RARP procedures performed by a single new attending surgeon from August 2015 to April 2019. Patients' demographics and operative details were assessed. Total operative time was divided and prospectively recorded in 7 parts: () docking robot, () dissecting seminal vesicles (SVs) () dissecting endopelvic fascia (EPF), () incising bladder neck (BN), () completing the dissection, () lymph node dissection, and () urethrovesical anastomosis (UVA) and robot undocking. Cumulative sum analysis was used to ascertain the LC for total operative time and the 7 parts of the procedure.
One hundred twenty consecutive RARPs were performed. The LC was overcome at 25 cases for total operative time, 13 cases for docking the robot, 33 cases for dissecting SVs, 31 cases for dissecting EPF, 46 cases for incising BN, 38 cases for prostate dissection, 25 cases for lymph node dissection, and 52 cases for UVA. Total operative time was decreased 22.8% ( < 0.0001) and time for robot docking, dissecting SVs, dissecting EPF, incising BN, completing prostate dissection, lymph node dissection, and UVA were decreased 16.7%, 30.5%, 29.5%, 36.2%, 37.3%, 32.2%, and 26.9%, respectively (all < 0.05).
We observed a 25-case LC for a fellowship-trained urologist to achieve stable operative performance of RARP surgery. Procedural components demonstrated variable LCs including the UVA that required upward of 52 cases.
确定一名近期完成机器人手术进修培训的泌尿外科医生在机器人辅助根治性前列腺切除术（RARP）中总手术时间及各个独立环节的学习曲线（LC）。
我们对一名新入职的主治医生在2015年8月至2019年4月期间所进行的RARP手术进行了回顾性分析。评估了患者的人口统计学资料和手术细节。总手术时间被分为7个部分并进行前瞻性记录：（）对接机器人，（）解剖精囊（SVs），（）解剖盆腔内筋膜（EPF），（）切开膀胱颈（BN），（）完成解剖，（）淋巴结清扫，以及（）尿道膀胱吻合术（UVA）和机器人脱机。采用累积和分析来确定总手术时间及该手术7个部分的学习曲线。
共连续进行了120例RARP手术。总手术时间在25例时克服学习曲线，对接机器人在13例时克服，解剖SVs在33例时克服，解剖EPF在31例时克服，切开BN在46例时克服，前列腺解剖在38例时克服，淋巴结清扫在25例时克服，UVA在52例时克服。总手术时间减少了22.8%（P<0.0001），对接机器人、解剖SVs、解剖EPF、切开BN、完成前列腺解剖、淋巴结清扫和UVA的时间分别减少了16.7%、30.5%、29.5%、36.2%、37.3%、32.2%和26.9%（均P<0.05）。
我们观察到一名完成进修培训的泌尿外科医生在RARP手术中达到稳定手术表现的学习曲线为25例。手术各个环节的学习曲线各不相同，其中UVA需要超过52例。
