Uchida Takato, Hasegawa Masanori, Umemoto Tatsuya, Nakajima Nobuyuki, Nitta Masahiro, Kawamura Yoshiaki, Shoji Sunao, Miyajima Akira
Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Surg Endosc. 2024 Jun;38(6):3416-3424. doi: 10.1007/s00464-024-10850-7. Epub 2024 May 9.
Robot-assisted radical prostatectomy (RARP) is a standard treatment for localized prostate cancer. We previously reported that a large amount of pelvic visceral fat and a small working space, as measured by three-dimensional image analysis, were significantly associated with prolonged console time in RARP, and these factors could be alternatives to the more clinically practical body mass index (BMI) and pelvic width (PW), respectively. Herein, we further investigated whether surgical proficiency affected surgical difficulty as measured by console time.
Medical records of 413 patients who underwent RARP between 2014 and 2020 at our institution were reviewed. Surgeons who had experience with over and under 100 cases were defined as "experienced" and "non-experienced," respectively. Multivariate logistic regression analyses were performed to identify factors that prolonged console time.
The median console times for RARP by experienced and non-experienced surgeons were 87.5 and 149.0 min, respectively; a difficult case was defined as one requiring time greater than the median. Among inexperienced surgeons, higher BMI (p < 0.001, odds ratio: 1.89) and smaller PW (p = 0.001, odds ratio: 1.86) were significant factors that increased console time; the complication rate was increased in patients with these factors. However, these factors did not significantly affect the console time or complication rate among experienced surgeons.
This study demonstrates that experienced surgeons may be able to overcome obesity- and small workspace-related surgical difficulties. The current analysis may provide useful information regarding unpredictable surgical risks and identify suitable cases for novices.
机器人辅助根治性前列腺切除术（RARP）是局限性前列腺癌的标准治疗方法。我们之前报道过，通过三维图像分析测量，大量盆腔内脏脂肪和狭小的操作空间分别与RARP中延长的控制台操作时间显著相关，并且这些因素可能分别是临床上更实用的体重指数（BMI）和骨盆宽度（PW）的替代指标。在此，我们进一步研究手术熟练程度是否会影响以控制台操作时间衡量的手术难度。
回顾了2014年至2020年在我们机构接受RARP的413例患者的病历。手术经验超过和不足100例的外科医生分别被定义为“经验丰富”和“经验不足”。进行多因素逻辑回归分析以确定延长控制台操作时间的因素。
经验丰富和经验不足的外科医生进行RARP的中位控制台操作时间分别为87.5分钟和149.0分钟；困难病例被定义为需要时间超过中位数的病例。在经验不足的外科医生中，较高的BMI（p < 0.001，比值比：1.89）和较小的PW（p = 0.001，比值比：1.86）是延长控制台操作时间的重要因素；有这些因素的患者并发症发生率增加。然而，这些因素对经验丰富的外科医生的控制台操作时间或并发症发生率没有显著影响。
本研究表明，经验丰富的外科医生可能能够克服与肥胖和操作空间狭小相关的手术困难。当前的分析可能为不可预测的手术风险提供有用信息，并为新手识别合适的病例。
