单一术者机器人辅助单孔腹腔镜前列腺癌根治术学习曲线分析

doi:10.3877/cma.j.issn.1674-3253.2023.01.007

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 30 -35. doi: 10.3877/cma.j.issn.1674-3253.2023.01.007

临床研究

单一术者机器人辅助单孔腹腔镜前列腺癌根治术学习曲线分析

魏勇¹, 沈露明², 朱辰³, 成向明³, 魏云飞³, 袁琳³, 苏健³, 朱清毅¹^,^†(

)

^1. 210011　南京医科大学第二附属医院泌尿外科；210029　南京中医药大学附属医院泌尿外科
^2. 210011　南京医科大学第二附属医院泌尿外科
^3. 210029　南京中医药大学附属医院泌尿外科

收稿日期:2021-09-24 出版日期:2023-02-01
通信作者: 朱清毅
基金资助:
江苏省卫生健康委员会科研项目(ZD2021028)

Analysis of single port robot-assisted laparoscopic prostatectomy curve of one single surgeon

Yong Wei¹, Luming Shen², Chen Zhu³, Xiangming Cheng³, Yunfei Wei³, Lin Yuan³, Jian Su³, Qingyi Zhu¹^,^†()

^1. Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; Department of Urology, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China
^2. Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
^3. Department of Urology, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China

Received:2021-09-24 Published:2023-02-01
Corresponding author: Qingyi Zhu

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引用本文：

魏勇, 沈露明, 朱辰, 成向明, 魏云飞, 袁琳, 苏健, 朱清毅. 单一术者机器人辅助单孔腹腔镜前列腺癌根治术学习曲线分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(01): 30-35.

Yong Wei, Luming Shen, Chen Zhu, Xiangming Cheng, Yunfei Wei, Lin Yuan, Jian Su, Qingyi Zhu. Analysis of single port robot-assisted laparoscopic prostatectomy curve of one single surgeon[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 30-35.

目的

评估单一术者在不同时间段开展的机器人辅助单孔腹腔镜前列腺癌根治术（sp-RALP）之手术效果，探讨该手术方式的学习曲线。

方法

回顾性分析南京中医药大学附属医院2020年1月至2020年12月由同一手术医师连续完成的100例sp-RALP的临床资料。按时间顺序将患者分为5组（A组即第一阶段组为第１~20例，B组即第二阶段组为第２1~40例，C组即第三阶段组为第41~60例，D组即第四阶段组为第61~80例，E组即第五阶段组为第81~100例），比较5组间的手术时间、术中出血、引流管留置时间、术后住院天数等方面的差异。

结果

随术者经验例数的累积，手术时间、术中出血量均呈下降趋势，A、B两组与C、D、E三组间分别对比差异均有统计学意义（P均<0.05），A组与B组间对比仅手术时间的差异存在统计学意义（P<0.05），C、D、E三组间两两对比差异均无统计学意义（P均>0.05）；而引流管留置时间、术后住院天数各组间研究的差异均无统计学意义（P均>0.05）。

结论

机器人辅助单孔腹腔镜前列腺癌根治术（sp-RALP）学习曲线相对陡峭，大约在40例手术经验积累之后基本掌握该技术，手术时间明显缩短，出血量明显减少。

关键词: 机器人, 前列腺癌, 单孔腹腔镜, 学习曲线

Objective

To evaluate the effect of single port robot-assisted laparoscopic prostatectomy (sp-RALP) performed by a single surgeon in different time periods, and explore the learning curve of the surgical method.

Method

A retrospective analysis of the clinical data of 100 prostate cancer patients received sp-RALP by the same surgeon in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2020 to December 2020 was conducted. Patients were divided into 5 groups in chronological order: group A (group in stage 1) included cases 1-20, group B (group in stage 2) included cases 21-40, group C (group in stage 3) included cases 41-60, group D (group in stage 4) included cases 61-80 and group E (group in stage 5) included cases 81-100. The operation time, intraoperative bleeding, indwelling time of drainage tube, and postoperative hospital stay among the 5 groups were compared.

Results

With increasing experiences, the operation time and intraoperative blood loss showed a downward trend. The differences among group A and groups C, D, and E were statistically significant and the differences among group B and groups C, D, and E were also statistically significant (P<0.05). groups A and B only exhibited a statistically significant difference in operation time (P<0.05), whereas, there was no statistically significant difference between the pairwise comparisons of groups C, D, and E (P>0.05). There were also no statistically significant differences in the drainage tube indwelling time and postoperative hospital stay among these groups (P>0.05).

Conclusions

The sp-RALP learning curve is relatively steep, and the technique is basically grasped after about 40 cases of surgical experience accumulation. The operation time is significantly shortened, and the amount of bleeding is significantly reduced.

Key words: Robot, Prostate cancer, Single port laparoscopy, Learning curve

图2 经腹腔入路机器人辅助单孔腹腔镜前列腺癌根治术中经尿道辅助盆腔淋巴结清扫

图3 各组前列腺癌患者前列腺穿刺病理分期对比小提琴图注：按手术时间顺序分为A、B、C、D、E五组，每组20例。a:临床分期小提琴图示各组患者间P值均>0.05，差异无统计学意义；b：Gleason评分1小提琴图示各组患者间P值均>0.05，差异无统计学意义；c：Gleason评分2小提琴图示各组患者间P值均>0.05，差异无统计学意义

表1 各组前列腺癌患者（每组20例）术前基本情况对比

组别	年龄[岁，(±s)]	体质指数BMI[kg/m²，(±s)]	前列腺体积[ml，(±s)]	PSA[ng/ml，M(Q)]
A组	71±9	24.8±2.7	47±18	13.5(33.3)
B组	70±8	23.5±3.0	51±30	15.9(11.4)
C组	70±8	23.4±2.2	46±21	14.3(24.7)
D组	70±8	23.1±2.4	47±16	10.3(52.2)
E组	71±8	22.7±3.2	42±18	14.2(35.4)
统计值	F=0.100	F=1.463	F=1.119	Z=0.512
P值	0.982	0.220	0.352	0.817

表1 各组前列腺癌患者（每组20例）术前基本情况对比

组别	年龄[岁，(±s)]	体质指数BMI[kg/m²，(±s)]	前列腺体积[ml，(±s)]	PSA[ng/ml，M(Q)]
A组	71±9	24.8±2.7	47±18	13.5(33.3)
B组	70±8	23.5±3.0	51±30	15.9(11.4)
C组	70±8	23.4±2.2	46±21	14.3(24.7)
D组	70±8	23.1±2.4	47±16	10.3(52.2)
E组	71±8	22.7±3.2	42±18	14.2(35.4)
统计值	F=0.100	F=1.463	F=1.119	Z=0.512
P值	0.982	0.220	0.352	0.817

表2 各组前列腺癌患者（每组20例）相关手术数据对比

组别	手术时间[min，(±s)]	机器人操作时间[min，(±s)]	术中出血量[ml，M(Q)]	引流管留置时间(d)	术后住院时间[d，(±s)]
A组	153±34	122±31	48（60）	5.2±2.3	14.9±10.0
B组	145±28	116±27	26（46）	6.5±5.4	12.8±4.4
C组	121±41	95±39	8（5）	6.5±2.4	11.8±3.4
D组	124±27	101±26	9（7）	8.4±6.5	12.1±6.2
E组	111±35	81±34	9（7）	7.1±2.2	11.2±7.5
统计值	F=5.450	F=4.953	Z=4.799	F=1.662	F=0.852
P值	<0.001	<0.001	<0.001	0.165	0.496

表2 各组前列腺癌患者（每组20例）相关手术数据对比

组别	手术时间[min，(±s)]	机器人操作时间[min，(±s)]	术中出血量[ml，M(Q)]	引流管留置时间(d)	术后住院时间[d，(±s)]
A组	153±34	122±31	48（60）	5.2±2.3	14.9±10.0
B组	145±28	116±27	26（46）	6.5±5.4	12.8±4.4
C组	121±41	95±39	8（5）	6.5±2.4	11.8±3.4
D组	124±27	101±26	9（7）	8.4±6.5	12.1±6.2
E组	111±35	81±34	9（7）	7.1±2.2	11.2±7.5
统计值	F=5.450	F=4.953	Z=4.799	F=1.662	F=0.852
P值	<0.001	<0.001	<0.001	0.165	0.496

图4 不同阶段前列腺癌患者围手术各指标分布趋势图

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