The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy
| Autor: | Francesco Chessa, Martina Rossi, Valerio Vagnoni, Marco Borghesi, Alexandre Mottrie, Riccardo Schiavina, Hussam Dababneh, Cristian Vincenzo Pultrone, Eugenio Brunocilla, Angelo Porreca, Lorenzo Bianchi |
|---|---|
| Přispěvatelé: | Schiavina R, Borghesi M, Dababneh H, Rossi MS, Pultrone CV, Vagnoni V, Chessa F, Bianchi L, Porreca A, Mottrie A, Brunocilla E |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment Operative Time 030232 urology & nephrology Urinary incontinence lcsh:RC870-923 03 medical and health sciences Postoperative Complications 0302 clinical medicine Erectile Dysfunction Robotic Surgical Procedures Training Humans Medicine Laparoscopy Aged Prostatectomy Urinary continence medicine.diagnostic_test business.industry Incidence Mentors Prostatic Neoplasms Perioperative Middle Aged lcsh:Diseases of the genitourinary system. Urology Operating table Treatment Outcome Urinary Incontinence Learning curve 030220 oncology & carcinogenesis Physical therapy Robot assisted radical prostatectomy Urologic Surgical Procedures medicine.symptom business Learning Curve Follow-Up Studies |
| Zdroj: | Archivio Italiano di Urologia e Andrologia, Vol 90, Iss 1, Pp 1-7 (2018) |
| Popis: | Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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