Technical surgical skill assessment of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.
Technical surgical skill assessment of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.
复制标题
机器人辅助根治性前列腺切除术后神经血管束解剖和尿失禁恢复的技术手术技能评估。
DOI：
10.1097/ju9.0000000000000035
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Hung,AndrewJ
中科院分区：
文献类型：
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作者：
Ma,Runzhuo;Cen,Steven;Forsyth,Edward;Probst,Patrick;Asghar,Aeen;Townsend,William;Hui,Alvin;Desai,Aditya;Tzeng,Michael;Cheng,Emily;Ramaswamy,Ashwin;Wagner,Christian;Hu,JimC;Hung,AndrewJ
目的：探讨神经血管束解剖质量与机器人辅助根治术后泌尿系恢复之间的关系。材料和方法：纳入2016年至2018年在2家机构接受RARP且术后随访≥ 1年的患者。主要结局是至排尿困难恢复的时间。在标准化培训后，由3名设盲评分员使用经验证的机器人技术解剖评估（DART）工具对手术视频进行独立评估。考克斯回归被用来测试DART评分和泌尿系统恢复之间的关联，同时调整相关的患者features.Results：121 RARP进行的23名外科医生具有不同的经验水平。中位随访时间为24个月（95%置信区间[CI] 20-28个月）。至恢复的中位时间为7.3个月（95% CI 4.7-9.8个月）。在调整患者年龄后，某些DART领域的得分较高，特别是组织收缩和效率，与恢复的几率增加显著相关（P<0.05）。结论：神经血管束分离术的技术评分在不同外科医生之间存在差异，并与排尿恢复相关。揭示影响患者结局的特定机器人解剖技能有可能集中进行手术培训。
Purpose:To examine the association between the quality of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.Materials and Methods:Patients who underwent RARPs from 2016 to 2018 in 2 institutions with≥ 1-year postoperative follow-up were included. The primary outcomes were time to urinary continence recovery. Surgical videos were independently assessed by 3 blinded raters using the validated dissection assessment for robotic technique (DART) tool after standardized training. Cox regression was used to test the association between DART scores and urinary continence recovery while adjusting for relevant patient features.Results:One hundred twenty one RARP performed by 23 surgeons with various experience levels were included. The median follow-up was 24 months (95% confidence interval [CI] 20-28 months). The median time to continence recovery was 7.3 months (95% CI 4.7-9.8 months). After adjusting for patient age, higher scores of certain DART domains, specifically tissue retraction and efficiency, were significantly associated with increased odds of continence recovery (P<. 05).Conclusions:Technical skill scores of neurovascular bundle dissection vary among surgeons and correlate with urinary continence recovery. Unveiling the specific robotic dissection skillsets which affect patient outcomes has the potential to focus surgical training.