The learning curve for robot-assisted radical cystectomy.
The learning curve for robot-assisted radical cystectomy.
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DOI：
10.4293/108680809x12589998404128
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Mohler JL
中科院分区：
文献类型：
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作者：
Guru KA;Perlmutter AE;Butt ZM;Piacente P;Wilding GE;Tan W;Kim HL;Mohler JL
作者发现，机器人辅助根治性膀胱切除术的学习曲线不断演变，以改善肿瘤学结果。机器人辅助的根治性膀胱切除术具有治愈膀胱癌患者的潜力，同时提供了微创手术的好处。我们试图评估这一技术要求很高的程序的学习曲线。在100名连续的患者中尝试了机器人辅助的根治性膀胱切除术。对我们的机器人辅助根治性膀胱切除术数据库进行了IRB批准的审查。比较手术经验增加的4组患者的手术总时间(OR)、膀胱切除时间、盆腔淋巴清扫(PLND)时间、估计失血量(EBL)、切缘阳性、并发症和住院时间。绘制了散点图和连续曲线，以开发机器人膀胱切除术学习曲线。总体OR时间从队列1的375分钟减少到队列4的352分钟，从切开到膀胱摘除的时间从队列1的187分钟缩短到队列4的165分钟，PLND时间从队列1的44分钟增加到队列4的77分钟，淋巴结转移率从队列1的14个节点增加到队列4的23个节点，手术切缘阳性从队列1的4例下降到队列4的0例。并发症发生率从队列1的9例下降到队列4的9例。随着技术的进步，机器人辅助根治性膀胱切除术的手术效果和肿瘤预后不断改善。
The authors found that the learning curve for robotassisted radical cystectomy is constantly evolving to improve oncologic outcomes. Robot-assisted radical cystectomy has the potential to cure patients from bladder cancer while offering the benefits of minimally invasive surgery. We sought to evaluate the learning curve for this technically demanding procedure. Robot-assisted radical cystectomy was attempted in 100 consecutive patients. An IRB-approved review of our robot-assisted radical cystectomy database was conducted. Total operative (OR) time, cystectomy time, pelvic lymph node dissection (PLND) time, estimated blood loss (EBL), margin positivity, complications, and length of hospital stay were compared among patients divided into 4 cohorts of increasing surgical experience. Scattergrams and continuous curves were plotted to develop a robotic cystectomy learning curve. Overall OR time decreased from 375 minutes in cohort 1 to 352 minutes in cohort 4, with less than 1% change in OR time after case 16. Time from incision to bladder extirpation decreased from 187 minutes in cohort one to 165 minutes in cohort 4. Time for PLND increased from 44 minutes in cohort 1 to 77 minutes in cohort 4. Lymph node yield increased from 14 nodes in cohort 1 to 23 nodes in cohort 4. Positive surgical margins decreased from 4 patients in cohort 1 to 0 patient in cohort 4. The complication rate had no change from 9 patients in cohort 1 to 9 patients in cohort 4. Operative results and oncologic outcomes for robot-assisted radical cystectomy constantly improve as the technique evolves.