Robotik retropubik prostatektomiye aşina cerrahlar için robot yardımlı perineal prostatektomi için öğrenme eğrisi

Abstract

Amaç: Robot yardımlı transperitoneal radikal prostatektomi ameliyatını rutin olarak gerçekleştiren cerrahlar için Robot yardımlı laparoskopik perineal prostatektomi (Robotik RPP) ameliyatının öğrenme eğrisinin belirlenmesi Gereç ve Yöntemler: Tek cerrah tarafından gerçekleştirilen ilk 120 Robotik RPP vakasının perioperatif verileri değerlendirildi. Operasyon zamanı, tahmini kan kaybı, postoperatif yatış süresi, komplikasyonlar ve pozitif cerrahi sınır olmak üzere perioperatif tüm veriler derlendi. Olgular operasyon zamanlarına göre dört gruba ayrıldılar; 1–30. olgular (Grup 1), 31–60.olgular (Grup 2), 61–90.olgular (Grup 3) and 91-120.olgular (Grup 4). Bulgular: Hastaların yaş ortalaması 61.4 (46-73) yıl ve PSA seviyeleri 8.4 (2-32) idi. Ortalama operasyon süresi 143.2 dakika iken cerrahi süresi progresif olarak zamanla azalmıştır. (Grup 1’den grup 4’e ; P<001). Ortalama konsol zaman 90.6 dakika iken grup 3 ve 4 arasında anlamlı bir fark bulunmuştur. (p=0.047). Ortalama hastane yatış süresi 1.6 gün iken 60.vakadan sonra anlamlı bir şekilde azalmaya başlamıştır. Katater çıkarılma zamanı Grup 4 için anlamlı bir şekilde daha kısa idi (P1vs4=0.012). Gruplar arasında patolojik evre, pozitif cerrahi sınır ve komplikasyonlar açısından anlamlı bir fark yoktu. Sonuç: Bu çalışma ile deneyimli robotik cerrahlar için Robotik RPP ameliyatında yeterliliğinin 90 vakadan sağlanabileceğini sonucuna varılmıştır.

Keywords

• Prostatektomi
• Robot yardımlı
• Perineal
• Öğrenme Eğrisi
• Prostat Kanseri

Determining the learning curve for robot-assisted radical perineal prostatectomy in surgeons familiar with robotic retropubic prostatectomy

Abstract

Objective: To investigate the learning curve for robot assisted laparoscopic radical perineal prostatectomy (robotic RPP) for surgeons who already perform transperitoneal robot assisted laparoscopic radical prostatectomy. Material and Methods: A total of initial 120 robotic RPP cases were analyzed for perioperative data from single surgeon performing to determine the learning curve. Perioperative all data are collected including operation time, estimated blood loss, postoperative length of stay, complications and positive surgical margin results. The consecutive patients were classified into four groups: cases 1–30 (Group 1), cases 31–60 (Group 2), cases 61–90 (Group 3) and cases 91-120 (Group 4). Results: Median age of 61.4 (46-73) years and PSA level was 8.4 (2-32). Mean operative time was 143.2 minutes, and the length of surgery progressively decreased over time (from group 1 to group 4; P<001). Mean console time was 90.6 minutes and significant differences was found group 3 vs. 4 (p=0.047). The mean length of stay was 1.6 days, and significantly decrease after 60 cases over time (P<0.001). Mean removal of the urethral catheter significantly earlier in group 4 (P1vs4=0.012). There was no statistically significant difference between the groups with respect to pathologic tumor Gleason score, positive surgical margine of the specimen and complications. Conclusions: This study suggests that surgical qualification for robotic RPP can be obtained at least after 90 cases for an experienced robotic surgeon.

Keywords

• Prostatectomy
• Robot-Assisted
• Perineal
• Learning Curve
• Prostate Cancer

References

1. 1. Culp, M.B., et al. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol, 2020. 77: 38. doi: 10.1016/j.eururo.2019.08.005
2. 2. Young HH (1945) The cure of cancer of the prostate by radical perineal prostatectomy (prostate-seminal vesiculectomy): history, literature and statistics of Young’s operation. J Urol 53:188–256 https://doi.org/10.1016/S0022-5347(17)70130-9
3. 3. Walsh PC, Lepor H, Eggleston JD (1983) Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 4:473 doi: 10.1002/pros.2990040506
4. 4. Abbou CC, Hoznek A, Salomon L et al (2000) Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol 2000 Sep 10(4) 520–523
5. 5. Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87:408–410 doi: 10.1046/j.1464-410x.2001.00115.x
6. 6. Herrell SD (2005) Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 66(5 suppl): 105–107 doi: 10.1016/j.urology.2005.06.084
7. 7. Gillitzer R (2004) Specific complications of radical perineal prostatectomy: a single institution study of more than 600 cases. J Urol 172(1):124–128 doi: 10.1097/01.ju.0000128570.39667.5e
8. 8. Saito S, Murakami G (2003) Radical perineal prostatectomy: a novel approach for lymphadenectomy from perineal incision. J Urol 170:1298–1300 doi: 10.1097/01.ju.0000084329.75188.e6

9. 9. Laydner H, Akca O, Autorino R, et al. Perineal robot-assisted laparoscopic radical prostatectomy: feasibility study in the cadaver model. J Endourol 2014;28:1479-1486. https://doi.org/10.1089/end.2014.0244
10. 10. Kaouk JH, Akca O, Zargar H, Caputo P, Ramirez D, Andrade H, Albayrak S, Laydner H, Angermeir K (2016) Descriptive technique and initial results for robotic radical perineal prostatectomy. Urology 94:129–138 doi: 10.1016/j.urology.2016.02.063
11. 11. Janoff DM, Parra RO. Contemporary appraisal of radical perineal prostatectomy. J Urol 2005;173:1863-1870. 10.1097/01.ju.0000161483.65619.b3
12. 12. Imperatore V, Cantiello F, Fusco F, et al. Radical perineal prostatectomy versus radical retropubic prostatectomy after previous prostate surgery: surgical and functional outcomes. Uro Int 2011;86:140-145. 10.1159/000317326
13. 13. Tugcu V, Akca O, Simsek A et al (2017) Robot-assisted radical perineal prostatectomy: first experience of 15 cases. Turk J Urol 43(4):476–483 https://doi.org/10.5152%2Ftud.2017.35488
14. 14. Tugcu V, Eksi M, Sahin S, Colakoglu Y, Simsek A, Evren I et al. Robot-assisted radical perineal prostatectomy: a review of 95 cases. BJU Int 2020; 125: 573–578 doi: 10.1111/bju.15018
15. 15. Guillonneau B, Rozet F, Barret E, et al. Laparoscopic radical prostatectomy: Assessment after 240 procedures. Urol Clin North Am 2001;28:189–202. doi: 10.1016/s1040-8428(02)00024-0
16. 16. Stolzenburg JU, Rabenalt R, Do M, et al. Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol 2006;49:491–500. doi: 10.1016/s1569-9056(06)60135-8
17. 17. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting - the learning curve and beyond: initial 200 cases. J Urol 2005; 174(1): 269-272. doi: 10.1097/01.ju.0000162082.12962.40
18. 18. Kaouk J Bertolo (2019) Single-site robotic platform in clinical practice: first cases in the USA. Minevra Urol Nefrl. 2019 Jun;71(3):294-298. doi: 10.23736/S0393-2249.19.03384-8
19. 19. Kim EJ, Kaldany A, Licht B, Single-Port Robotic Radical Prostatectomy: Short-Term Outcomes and Learning Curve, J Endourol 2022 Oct; 36(10):1285-1289. doi: 10.1089/end.2021.0885.
20. 20. Bock D, Nyberg M, Lantz A, Carlsson SV, Sjoberg DD, Carlsson S, Stranne J, Steineck G, Wiklund P, Haglind E, Bjartell A. Learning curve for robot-assisted laparoscopic radical prostatectomy in a large prospective multicentre study. Scand J Urol. 2022 Jun;56(3):182-190. doi: 10.1080/21681805.2022.2070274. Epub 2022 May 12.