Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy
Surgeon Performance Predicts Early Continence After Robot-Assisted Radical Prostatectomy
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DOI：
10.1089/end.2017.0284
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发表时间：
2017-09-01
影响因子：
2.7
通讯作者：
Grantcharov, Teodor P.
中科院分区：
文献类型：
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作者：
Goldenberg, Mitchell G.;Goldenberg, Larry;Grantcharov, Teodor P.
引言：有有限但令人信服的证据支持外科医生技术性能在影响患者结局方面的作用。迄今为止，这一概念在腔内泌尿外科手术中尚未得到充分研究。我们假设，外科医生的技术性能在预测机器人辅助根治性直肠癌切除术（RARP）后早期恢复直肠癌中起着重要作用。材料和方法：我们进行了一项回顾性的，匹配的病例对照分析前瞻性收集的未经编辑的RARP内窥镜视频由一名外科医生进行。具有术中视频分析专业知识的设盲观察者使用机器人技能总体评价评估（GEARS）和通用错误评级工具（GERT）评价RARP的临床相关步骤。主要结局是术后3个月的排尿状态，定义为患者使用少于或等于一个预防垫。Mann-Whitney U检验检验了病例和对照组之间预测变量的差异，并使用二元Logistic回归模型进行多变量分析。结果：24例失禁患者的年龄，体重指数，术前国际前列腺症状评分，使用后/前栓结，前列腺重量和学习曲线位置相匹配。使用GERT，未观察到组间错误的统计学显著差异。在多变量分析中，总体病例GEARS评分独立预测3个月的预后（比值比[OR] = 0.55，95%置信区间[CI] 0.33-0.91），尿道膀胱吻合术也是如此（OR = 0.70，95%CI 0.50-0.97）和膀胱颈GEARS评分（OR = 0.69，95%CI 0.51-0.94）。结论：我们的研究产生了一个假设，即RARP中外科医生的技术性能和功能结局之间可能存在联系。这种关系可能对未来泌尿科医生的认证和培训产生影响，并需要进一步调查。
Introduction: There is limited, yet compelling evidence supporting the role of surgeon technical performance in influencing patient outcomes. To date, this concept has been underexplored in endourologic procedures. We hypothesized that a surgeon's technical performance plays a role in predicting an early return to continence after robot-assisted radical prostatectomy (RARP).Materials and Methods: We conducted a retrospective, matched case-control analysis of prospectively collected unedited RARP endoscopic videos performed by a single surgeon. A blinded observer with expertise in intraoperative video analysis evaluated clinically relevant steps of RARP using the global evaluative assessment of robotic skill (GEARS) and the generic error rating tool (GERT). The primary outcome was continence status at 3 months postoperatively, defined as patient use of less than or equal to a single precautionary pad. Mann-Whitney U tests examined differences in predictor variables between cases and controls, and multivariate analysis was conducted using binary logistic regression models.Results: Twenty-four incontinent patients were matched for age, body mass index, preoperative International Prostate Symptoms Score, use of posterior/anterior hitch, prostate weight, and learning curve position. No statistically significant difference in errors between groups was observed using the GERT. On multivariate analysis, overall case GEARS score was independently predictive of 3-month continence status (odds ratios [OR] = 0.55, 95% confidence interval [CI] 0.33-0.91), as were urethrovesical anastomosis (OR = 0.70, 95% CI 0.50-0.97) and bladder neck GEARS scores (OR = 0.69, 95% CI 0.51-0.94).Conclusions: Our study generates the hypothesis that there may be a link between surgeon technical performance and functional outcomes in RARP. This relationship may have implications for the accreditation and training of future urologists and warrants further investigation.