Yusuf İlker ÇÖMEZ, Melih BALCI, Doğukan SÖKMEN, Kamil Gökhan ŞEKER, Volkan TUĞCU

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

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.

Anahtar Kelimeler:

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

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,

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