Service of Urology, Universitary Hospital of La Coruña, 15006 A Coruña, Spain.
Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Medicina (Kaunas). 2024 Jun 24;60(7):1032. doi: 10.3390/medicina60071032.
Robot-assisted radical prostatectomy (RARP) is a complex surgery with a steep learning curve (LC). No clear evidence exists for how previous laparoscopic experience affects the RARP LC. We report the LC of three surgeons with vast experience in laparoscopy (more than 400 procedures), analyzing the results of functional and oncological outcomes under the "Trifecta" concept (defined as the achievement of continence, potency, and oncological control free of biochemical recurrence). The surgical experience of the three surgeons from September 2021 to December 2022, involving 146 RARP consecutive patients in a single institution center, was evaluated prospectively. Erectile disfunction patients were excluded. ANOVA and chi-square test were used to compare the distribution of variables between the three surgeons. LC analysis was performed using the cumulative sum control chart (CUSUM) technique to achieve trifecta. The median age was 65.42 (±7.34); the clinical stage were T1c (68%) and T2a (32%); the biopsy grades were ISUP 1 (15.9%), ISUP 2 (47.98), and ≥ISUP 3 (35%). The median surgical time was 132.8 (±32.8), and the mean intraoperative bleeding was 186 cc (±115). Complications included the following: Clavien-Dindo I 8/146 (5.47%); II 9/146 (6.16%); and III 3/146 (2.05%). Positive margins were reported in 44/146 (30.13%). The PSA of 145/146 patients (99%) at 6 months was below 0.08. Early continence was achieved in 101/146 (69.17%), 6-month continence 126/146 (86%), early potency 51/146 (34.9%), and 6-month potency 65/146 (44%). Surgeons "a", "b", and "c" performed 50, 47, and 49 cases, respectively. After CUSUM analysis, the "Trifecta" LC peak was achieved at case 19 in surgeon "a", 21 in surgeon "b", and 20 in surgeon "c". Conclusions: RARP LC to accomplish "Trifecta" can be significantly reduced in surgeons with previous experience in laparoscopy and be achieved at around 20 cases.
机器人辅助根治性前列腺切除术（RARP）是一项具有陡峭学习曲线（LC）的复杂手术。目前尚无明确证据表明先前的腹腔镜经验如何影响 RARP LC。我们报告了三位在腹腔镜手术方面拥有丰富经验（超过 400 例手术）的外科医生的 LC，根据“三位一体”（定义为实现控尿、勃起功能和无生化复发的肿瘤控制）概念分析了功能和肿瘤学结果。对 2021 年 9 月至 2022 年 12 月在单中心机构进行的 146 例连续 RARP 患者的外科医生手术经验进行了前瞻性评估。排除了勃起功能障碍患者。使用方差分析和卡方检验比较了三位外科医生之间变量的分布。使用累积和控制图（CUSUM）技术进行 LC 分析，以实现三位一体。中位年龄为 65.42（±7.34）；临床分期为 T1c（68%）和 T2a（32%）；活检分级为 ISUP 1（15.9%）、ISUP 2（47.98%）和≥ISUP 3（35%）。中位手术时间为 132.8（±32.8），术中平均出血量为 186cc（±115）。并发症包括以下：Clavien-Dindo I 8/146（5.47%）；II 9/146（6.16%）；和 III 3/146（2.05%）。报告 44/146（30.13%）例阳性切缘。146 例患者中有 145 例（99%）在 6 个月时 PSA 低于 0.08。146 例患者中有 101 例（69.17%）早期获得控尿，146 例中有 126 例（86%）获得 6 个月控尿，146 例中有 51 例（34.9%）早期勃起功能正常，146 例中有 65 例（44%）获得 6 个月勃起功能正常。外科医生“a”、“b”和“c”分别完成了 50、47 和 49 例手术。经过 CUSUM 分析，外科医生“a”的“三位一体”LC 峰值出现在第 19 例，外科医生“b”出现在第 21 例，外科医生“c”出现在第 20 例。结论：在腹腔镜手术方面经验丰富的外科医生中，RARP LC 达到“三位一体”的水平可以显著降低，约为 20 例。
