Urology · 2014
Impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Di Pierro Giovanni Battista, Wirth Johann Gregory, Ferrari Matteo, Danuser Hansjörg, Mattei Agostino
Аннотация
OBJECTIVE: To assess the impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection for intermediate- or high-risk clinically localized prostate cancer.
METHODS: From November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5 days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3 months. Variables were compared using chi-square and Wilcoxon tests.
RESULTS: Overall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (P = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (P <.01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (P = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: P <.01). Renal function was unaltered postoperatively.
CONCLUSION: A surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected.
METHODS: From November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5 days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3 months. Variables were compared using chi-square and Wilcoxon tests.
RESULTS: Overall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (P = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (P <.01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (P = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: P <.01). Renal function was unaltered postoperatively.
CONCLUSION: A surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected.
Предметные рубрики MeSH
AgedCreatine KinaseHumansIntraoperative ComplicationsKidneyLearning CurveLymph Node ExcisionLymph NodesMaleMiddle AgedMinimally Invasive Surgical ProceduresPatient PositioningPostoperative ComplicationsProspective StudiesProstateProstatectomyProstatic NeoplasmsRegression AnalysisRobotic Surgical ProceduresTreatment Outcome