Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy
Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy
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DOI：
10.1111/bju.14857
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发表时间：
2019-07-22
影响因子：
4.5
通讯作者：
Hung, Andrew J.
中科院分区：
文献类型：
--
作者：
Chen, Jian;Chu, Tiffany;Hung, Andrew J.
目的 评估外科医生经验、身体习惯和骨盆尺寸对机器人辅助根治性前列腺切除术 (RARP) 后外科医生表现和患者预后的影响。患者、受试者和方法 由三名放射科医生通过术前磁共振成像和计算机断层扫描测量了 78 名 RARP 患者的骨盆尺寸。外科医生自动性能指标（APM [仪器运动跟踪和系统事件数据，即摄像机运动、第三臂交换、能源使用]）是在 RARP 期间通过系统数据记录仪（Intuitive Surgical，美国加利福尼亚州桑尼维尔市）获得的。进行了两项分析：分析 1，使用线性回归检查患者特征、骨盆尺寸和既往外科医生 RARP 病例量对 APM 的影响；分析2，通过多变量回归分析患者体型、骨盆测量和外科医生经验对短期和长期结果的影响。结果分析 1 显示，虽然外科医生经验对 APM 数量的影响最大（P < 0.044），但患者的体重指数、骨盆尺寸和前列腺大小也影响每个手术步骤中的 APM（分别为 P < 0.043、P < 0.046、P < 0.034）。分析2表明，RARP持续时间受骨盆深度（β = 13.7，P = 0.039）和前列腺体积（β = 0.5，P = 0.024）的显着影响。骨盆越宽越浅，产生阳性切缘的可能性较小（比值比 0.25，95% 置信区间 [CI] 0.09-0.72）。多变量分析显示，尿失禁恢复与外科医生之前的 RARP 经验相关（风险比 [HR] 2.38，95% CI 1.18-4.81；P = 0.015），但与骨盆尺寸无关（HR 1.44，95% CI 0.95-2.17）。结论 由于骨盆较窄和较深，手术工作空间有限，确实会影响外科医生的表现和患者的预后，最明显的是手术时间较长和切缘阳性率增加。
Objectives To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical prostatectomy (RARP). Patients, Subjects and Methods The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third-arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analysed by multivariable regression. Results Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P < 0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P < 0.043, P < 0.046, P < 0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (beta = 13.7, P = 0.039) and prostate volume (beta = 0.5, P = 0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18-4.81; P = 0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95-2.17). Conclusion Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.