Robotic-assisted laparoscopic prostatectomy: What is the learning curve?
Robotic-assisted laparoscopic prostatectomy: What is the learning curve?
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DOI：
10.1016/j.urology.2005.06.084
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发表时间：
2005-11-01
期刊：
影响因子：
2.1
通讯作者：
Smith, JA
中科院分区：
文献类型：
--
作者：
Herrell, SD;Smith, JA
尽管机器人辅助腹腔镜直肠切除术（RALP）的设备越来越广泛，但很少有外科医生获得掌握RALP所需的技能和经验。一个重要的问题一直是必要的培训和经验（即“学习曲线”），必要的合格的外科医生成为专家在RALP。资深作者（J.A.S.）具有>2500例根治性耻骨后尿道切除术（RRP）和>350例RALP手术的经验。他评估了自己在RALP方面取得专业知识的学习曲线。因为没有客观的标准来定义RALP的专业知识，专家地位的实现取决于外科医生的舒适度，经验和替代方法的结果。具有开放手术丰富经验的外科医生可能会因为期望而将学习曲线“设置”得更高。RALP结果与RRP常规获得的结果相当，直到>= 150次手术后才获得。直到250例RALP手术后，外科医生的舒适度和信心才与RRP相当。将RALP的学习曲线定义为外科医生可以提供与替代手术入路可获得的结果相当的结果的点，这意味着该点取决于外科医生的经验和专业知识。与经验丰富的开放手术外科医生相比，唯一或主要经验是腹腔镜或机器人入路的外科医生可能对学习曲线有不同的看法。
Although equipment for performance of robotic-assisted laparoscopic prostatectomy (RALP) is becoming more widely available, few surgeons have acquired the skill and experience necessary to master RALP. A significant issue has been the requisite training and experience (ie, the "learning curve") necessary for a qualified surgeon to become an expert at RALP. The senior author (J.A.S.) has experience with >2500 radical retropubic prostatectomy (RRP) and >350 RALP procedures. He assessed his learning curve in achieving expertise with RALP. Because there are no objective measures to define expertise with RALP, achievement of expert status depends on the surgeon's comfort, experience, and results with alternative approaches. Surgeons with extensive experience with open approaches may "set the bar" higher for the learning curve because of expectations. RALP results comparable to those obtained routinely with RRP were not achieved until after >= 150 procedures. Surgeon comfort and confidence comparable to that with RRP did not occur until after 250 RALP procedures. Defining the learning curve for RALP as the point at which a surgeon could provide outcomes comparable to those obtainable with alternative surgical approaches means that the point varies, depending on the experience and expertise of the surgeon. Surgeons whose sole or dominant experience is with laparoscopic or robotic approaches may have a different perception of the learning curve compared with an experienced open surgeon.