Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents
| Autor: | Aldo Massimo Bocciardi, Christopher G. Eden, Silvia Secco, Koon Ho Rha, Pedro Sanchez De La Muela, Karen Fransis, Kun Yuan Chiu, Christophe Assenmacher, Ugur Boylu, Tomoaki Miyagawa, Harry Lee, Antonio Galfano, Akio Matsubara, Keith J. Kowalczyk, Paolo Dell'Oglio, Prasanna Sooriakumaran |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty 2019-20 coronavirus outbreak Time Factors Coronavirus disease 2019 (COVID-19) Urology Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) medicine.medical_treatment 030232 urology & nephrology 03 medical and health sciences 0302 clinical medicine Robotic Surgical Procedures medicine Humans Aged Retrospective Studies Prostatectomy Urinary continence business.industry Prostatic Neoplasms Perioperative Middle Aged Surgery Treatment Outcome Learning curve 030220 oncology & carcinogenesis Human medicine business Organ Sparing Treatments Learning Curve |
| Zdroj: | BJU international |
| ISSN: | 1464-410X 1464-4096 |
| DOI: | 10.1111/bju.15196 |
| Popis: | OBJECTIVE: Retzius-sparing robot-assisted radical prostatectomy (RSP) is a novel approach for radical prostatectomy that was described by our group for the first time in 2010 and is spreading all around the world. The aim of the present study was to assess the effect of surgical experience (SE) on perioperative, functional and oncological outcomes during the first 50 RSP cases performed by a naive surgeon for this novel approach. MATERIALS AND METHODS: We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centers. Pre-, peri- and post- operative features of the first 50 patients operated by each surgeon in all the participating centers were collected. The effect of the SE on perioperative, functional and oncological outcomes was firstly evaluated after stratification of surgical experience in initial (≤25) and expert cases (>25) and after using locally weighted scatter-plot smoother (LOWESS) function to graphically explore the relationship between SE and the outcomes of interest. RESULTS: We evaluated 626 patients. Median follow-up was 13 months in the first group and 9 months in the second (p=0.002). Preoperative features were overlapping between the two groups. Lower console time (140 min vs 120 minutes, p=0.001) and a trend for lower complications rates (13 vs 5.5%, p=0.038) were observed in the second group. The relationship between SE and console time, immediate urinary continence recovery and Clavien Dindo complications ≥2 was linear without reaching a plateau after 50 cases. Conversely, a non-linear relationship was observed between SE and PSMs. CONCLUSIONS: We reported the first multi-center experience of Retzius-sparing RARP during the learning curve. We found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSMs rates did not clearly enhance over the first 50 cases. |
| Databáze: | OpenAIRE |
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