Williams Zoe, Saad Jeremy, Ayeni Femi E, Wang Henry, Zhong Wenjie, Gendy Rasha, Arianayagam Mohan, Canagasingham Bertram, Goolam Ahmed, Jeffery Nicola, Kam Jonathan, Khadra Mohamed, Ko Raymond, Mehan Nicholas, Varol Celalettin, Thangasamy Isaac
Nepean Urology Research Group, Sydney, Australia.
Department of Urology, Nepean Hospital, Derby St, Kingswood, Sydney, NSW, Australia.
J Robot Surg. 2025 May 13;19(1):215. doi: 10.1007/s11701-025-02277-6.
Robotic-assisted laparoscopic prostatectomy (RALP) is the dominant surgical approach for prostate cancer worldwide. The steep learning curve in robotic surgery is eased by modular training and the da Vinci Surgical System dual console, where supervisors can assume control of the robot from a secondary console if required. Here we evaluate the safety of robotic training by comparing pathological and peri-operative outcomes of RALPs performed predominantly by urology trainees supported by a modular training approach and dual console supervision with RALPs performed predominantly by specialist robotic surgeons. This prospective cohort study examines RALPs performed at a tertiary robotic training centre in Australia between February 2017 and August 2018. Each case was divided into 13 steps from port placement to specimen retrieval. A case was considered a 'trainee-lead case' if the trainee completed more than 75% of the operative steps. We compared patient demographics, operative parameters, peri-operative outcomes, and pathological outcomes between groups. Differences between groups were measured using Fisher's exact test for categorical data and the unpaired Student's t-test for continuous data. Of 126 cases in this study, 39 (31%) were trainee-led cases and 87 (69%) were specialist lead cases. There was no significant difference in operative or pathological outcomes between trainee-lead cases and specialist-lead cases. Our results compared favourably with local and international benchmarks. RALP performed by trainees using a modular training approach and supported by the dual console can have equivalent peri-operative and pathological outcomes to specialist-led cases. This is achieved by graded progression and dual console supervision.
机器人辅助腹腔镜前列腺切除术（RALP）是全球范围内治疗前列腺癌的主要手术方式。模块化培训和达芬奇手术系统双控制台缓解了机器人手术中陡峭的学习曲线，在必要时，主管人员可以从辅助控制台接管机器人的控制权。在此，我们通过比较主要由泌尿外科实习生采用模块化培训方法并在双控制台监督下进行的RALP手术与主要由专业机器人外科医生进行的RALP手术的病理及围手术期结果，来评估机器人培训的安全性。这项前瞻性队列研究考察了2017年2月至2018年8月在澳大利亚一家三级机器人培训中心进行的RALP手术。每个病例从端口置入到标本取出分为13个步骤。如果实习生完成了超过75%的手术步骤，则该病例被视为“实习生主导病例”。我们比较了两组患者的人口统计学特征、手术参数、围手术期结果和病理结果。使用Fisher精确检验分析分类数据组间差异，使用非配对学生t检验分析连续数据组间差异。本研究的126例病例中，39例（31%）为实习生主导病例，87例（69%）为专家主导病例。实习生主导病例和专家主导病例在手术或病理结果上无显著差异。我们的结果与本地和国际基准相比具有优势。实习生采用模块化培训方法并在双控制台支持下进行的RALP手术，其围手术期和病理结果可与专家主导的病例相当。这是通过分级进展和双控制台监督实现的。
