背景:机器人手术中的一个重要问题是泌尿科医师的培训和进行机器人辅助的部分肾切除术(RAPN)的学习曲线,特别是对于那些需要血管夹紧的手术。
方法:我们回顾性招募了333名患者,在2014年1月12日至2020年12月期间接受RAPN。手术复杂性,手术持续时间,围手术期并发症,并对每位患者进行夹钳评估。在经验丰富的外科医生和3名具有机器人手术初始经验的泌尿科医师之间进行了比较。
结果:RAPN的总数为333,其中172个由首席执行,142个由团队执行。分析数据,在机器人手术的初步训练之后,在完全独立进行15次手术后,可以进行中等复杂性的手术(肾脏评分6-7)。为了在可能的血管夹闭和热缺血时间<25分钟的情况下进行高复杂性肿瘤(RENAL评分8-9),需要至少25个完全独立的程序。关于手术持续时间的比较没有显着差异(p=0.19),并发症(p=0.44)和阳性切缘(p=0.96)。
结论:复杂程序的机器人训练,术后并发症发生率低,可接受的正利润率和可持续的成本效益持续时间,需要最少数量的中等复杂性程序,在我们的研究中,我们确定了25个程序,考虑到我们3名外科医生在培训中的简单程序的初始能力。
BACKGROUND: An important issue in robotic surgery is the training of urologists and the learning curve to perform a robot-assisted partial nephrectomy (RAPN), especially for those procedures that require vascular clamping.
METHODS: We retrospectively enrolled 333 patients, undergoing RAPN in the period between 01/2014 and 12/2020. Surgical complexity, surgery duration, perioperative complications, and clamping were evaluated for each patient. Comparisons were made between an experienced surgeon and 3 urologists with initial experience in robotic surgery.
RESULTS: Total number of RAPN was 333, of wich 172 were performed by the chief and 142 by the team. Analyzing the data, after an initial training in robotic surgery, it\'s possible to perform surgery of medium complexity (RENAL score 6-7) after 15 procedures performed in total independence. To proceed to high complexity tumors (RENAL score 8-9) with possible vascular clamping and warm ischemia time <25 minutes at least 25 completely independent procedures are required. There were no significant differences in the comparisons regarding the duration of the procedures (p = 0.19), complications (p = 0.44) and positive margins (p = 0.96).
CONCLUSIONS: Robotic training for complex procedures, with low intra and postoperative complication rates, acceptable positive margin rates and sustainable cost-effective durations, requires a minimum number of medium complexity procedures, which in our study we have identified as 25 procedures, considering the initial ability in simple procedures of our 3 surgeons in training.