The learning curve for robot-assisted radical cystectomy with total intracorporeal urinary diversion based on radical cystectomy pentafecta.

Autor:	Noh TI; Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea., Shim JS; Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea., Kang SG; Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea., Cheon J; Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea., Pyun JH; Department of Urology, Sungkyunkwan University School of Medicine, Seoul, South Korea., Kang SH; Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2022 Oct 18; Vol. 12, pp. 975444. Date of Electronic Publication: 2022 Oct 18 (Print Publication: 2022).
DOI:	10.3389/fonc.2022.975444
Abstrakt:	Objective: To analyze the learning curve for robot- assisted radical cystectomy (RARC) with total intracorporeal urinary diversion (ICUD) in terms of both time efficiency and quality of surgery based on radical cystectomy (RC)-pentafecta. Patients and Methods: We identified 203 consecutive patients who underwent RARC with ICUD of the ileal conduit (IC, 85) and orthotopic neobladder (ONB, 118) performed by a single surgeon between 2011 and 2021. We grouped ten consecutive patients into time-associated blocks according to the operation order. Process efficiency and operation quality were measured based on the surgeon's console time and attainment/score sum of RC-pentafecta. The overcoming point of the learning curve was defined graphically and statistically. Results: The mean follow-up period was 44.5 ± 30.7 months. Of the 203 patients, 109 (53.7%) attained the five criteria of RC-pentafecta (ONB vs IC, 50.6% vs. 55.9%, p = 0.35). The attainment rate and sum of the RC-pentafecta score of the third group were not significantly different from those of all patients (40.0% vs. 53.7%, p = 0.369, 4.00 ± 1.05 vs. 4.41 ± 0.75, p = 0.137, respectively), and the proficiency in operation quality was satisfactory in the third group. The console times continually improved and stabilized after the 140 th case (IC, 60; ONB, 80), and the attainment rate and sum of the RC-pentafecta were significantly different between before and after the 140 th case (p<0.001). Conclusion: A single surgeon's learning curve for RARC with ICUD and pelvic lymph node dissection (PLND) showed an acceptable level of proficiency after 30 consecutive cases in terms of the operation quality. However, for an expert surgeon, 140 cases were required to reach a plateau in time efficiency and second leap with the RC-pentafecta. RARC with ICUD and PLND can be performed safely without compromising functional outcomes and complications through sharing and transmission of standardized techniques. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Noh, Shim, Kang, Cheon, Pyun and Kang.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu