Predictors of trainees' proficiency during the learning curve of robot-assisted radical prostatectomy at high- -volume institutions: results from a multicentric series.

Autor:	Anceschi U; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Morelli M; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Flammia RS; Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy., Brassetti A; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Dell'Oglio P; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Galfano A; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Tappero S; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Vecchio E; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Martiriggiano M; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Luciani LG; APSS, Santa Chiara Regional Hospital, Department of Urology, Trento, Italy., Sperduti I; IRCCS Regina Elena National Cancer Institute, Biostatistical Unit, Rome, Italy., Albisinni S; University of Bruxelles, Erasme Hospital, Service de Urologie, Bruxelles, Belgium., Tuderti G; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Prata F; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Ferriero MC; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Bove AM; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Mastroianni R; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Spadaro G; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy., Russo A; IRCCS Regina Elena National Cancer Institute, Department of Research, Advanced Diagnostics and Technological Innovation, Pathology Unit, Rome, Italy., Mattevi D; APSS, Santa Chiara Regional Hospital, Department of Urology, Trento, Italy., Tufano A; Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy., Leonardo C; Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy., Lombardo R; Sant' Andrea Hospital, 'Sapienza' University, Department of Urology, Rome, Italy., De Nunzio C; Sant' Andrea Hospital, 'Sapienza' University, Department of Urology, Rome, Italy., Cai T; APSS, Santa Chiara Regional Hospital, Department of Urology, Trento, Italy., Quackels T; University of Bruxelles, Erasme Hospital, Service de Urologie, Bruxelles, Belgium., Bocciardi AM; Ospedale Niguarda Ca' Granda, Department of Urology, Milan, Italy., Simone G; IRCCS 'Regina Elena' National Cancer Institute, Department of Urology, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Central European journal of urology [Cent European J Urol] 2023; Vol. 76 (1), pp. 38-43. Date of Electronic Publication: 2023 Mar 03.
DOI:	10.5173/ceju.2023.260
Abstrakt:	Introduction: The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers. Material and Methods: Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant. Results: Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15-8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3). Conclusions: Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes. Competing Interests: The authors declare no conflicts of interest. (Copyright by Polish Urological Association.)
Databáze:	MEDLINE
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