Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon's experience
Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon's experience
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DOI：
10.5489/cuaj.2805
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发表时间：
2015-07-01
影响因子：
1.9
通讯作者：
Zorn, Kevin C.
中科院分区：
文献类型：
--
作者：
Alenizi, Abdullah M.;Valdivieso, Roger;Zorn, Kevin C.
简介：我们评估了由专家RARP外科医生完成机器人辅助根治性直肠癌切除术（RARP）各个步骤所需的平均时间。其目的是帮助建立一个基于时间的基准，以在学徒期间达到目标。此外，我们的目的是评估术前患者的因素，这可能会延长这些个别steps.Methods的手术时间：我们回顾性地确定了247例谁接受RARP，在我们的机构由经验丰富的机器人外科医生进行。记录基线患者特征和每个步骤的持续时间。结果：多因素分析显示，肥胖是以下手术时间延长的重要预测因素：对接术（OR 1.96）、尿道分离术（OR 3.13）和膀胱尿道吻合术（VUA）（OR 2.63）。前列腺体积也是背静脉复合体结扎（OR 1.02）、膀胱颈分离（OR 1.03）、蒂控制（OR 1.04）、尿道分离（OR 1.02）和VUA（OR 1.03）手术时间较长的重要预测因素。膀胱颈分裂延长的预测存在的中叶（OR 5.03）。只有肥胖（OR 2.56）和前列腺体积（OR 1.04）是较长的整体手术时间的预测因子。结论：肥胖和前列腺体积是较长的整体手术时间的强有力的预测因子。此外，两者都可以预测几个单独的RARP步骤的延长时间。中叶的存在是膀胱颈分裂较长的一个强有力的预测因素。在RARP培训期间应考虑这些因素。
Introduction: We evaluated the average time required to complete individual steps of robotic-assisted radical prostatectomy (RARP) by an expert RARP surgeon. The intent is to help establish a time-based benchmark to aim for during apprenticeship. In addition, we aimed to evaluate preoperative patient factors, which could prolong the operative time of these individual steps.Methods: We retrospectively identified 247 patients who underwent RARP, performed by an experienced robotic surgeon at our institution. Baseline patient characteristics and the duration of each step were recorded. Multivariate analysis was performed to predict factors of prolonged individual steps.Results: In multivariable analysis, obesity was a significant predictor of prolonged operative time of: docking (odds ratio [OR] 1.96), urethral division (OR 3.13), and vesico-urethral anastomosis (VUA) (OR 2.63). Prostate volume was also a significant predictor of longer operative time in dorsal vein complex ligation (OR 1.02), bladder neck division (OR 1.03), pedicle control (OR 1.04), urethral division (OR 1.02), and VUA (OR 1.03). A prolonged bladder neck division was predicted by the presence of a median lobe (OR 5.03). Only obesity (OR 2.56) and prostate volume (OR 1.04) were predictors of a longer overall operative time.Conclusions: Obesity and prostate volume are powerful predictors of longer overall operative time. Furthermore, both can predict prolonged time of several individual RARP steps. The presence of a median lobe is a strong predictor of a longer bladder neck division. These factors should be taken into consideration during RARP training.