通盤規劃如何避免及處理達文西機器手臂輔助腹腔鏡根除性攝護腺
切除術的併發症-單一外科醫師執行 1000 例之經驗
歐宴泉1、楊晨洸1、張光喜2、王約翰 3、熊小澐4
臺中榮民總醫院外科部泌尿外科1，研究部2，病理部3，放射線部4
“prevention and management of complications during robotic-assisted laparoscopic radical prostatectomy from comprehensive planning : experience of a single surgeon of 1000 cases”
Yen-Chuan Ou, M.D., Ph.D. 1, Chun-Kuang Yang, M.D. 1, Kuangh-Si Chang, 2 John Wang, M.D. 3, Siu-Wan Hung, M.D.4
Division of Urology, Department of Surgery1, Department of Research, 2 Department of Pathology3, Department of Radiation4,
Taichung Veterans General Hospital, Taichung, Taiwan
INTRODUCTION AND OBJECTIVES：To report the complications of 1000 cases of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon in Taiwan.
METHODS：Complication (Clavien system) rates were prospectively assessed in 1000 consecutive patients undergoing RALP ( Group I: cases 1-200, II: 201-400, III: 401-600, IV: 601-800 and V:801-1000). Clinical pathway was described below: Patients were allowed to have water and then resumed regular diet on POD 1-2. The drainage tube was removed and intravenous fluid discontinued on POD 1-3. Urine leakage was defined as urine drainage > 100 ml at POD 4. Ileus was defined as inability to resume normal diet at POD 4.
RESULTS：Significantly less blood loss occurred after every 200 cases of RALP (Group I 180 ml, II 119 ml, III 92 ml, IV 91ml, V: 88 ml, p<0.05). Blood transfusion (BT) incidence was 3.5%, 0.5%, 1%, 0%,0.5% in Groups I, II, III, IV and V, respectively. The total complication was 6.4% (64/1000) (surgical/medical : 5% / 1.4%). Complication rate was 12%, 6%, 6%,4% and 4% in Groups I, II, III,IV and V respectively. Major complications (grade III-IV) were 2.5%, 1.5%, 2%,1% and 1% in Groups I, II, III,V and V, respectively. The most common complication was blood transfusion (11/1000=1.1%).
CONCLUSIONS：Learning curve for every 200 cases of RALP showed significantly less blood loss and blood transfusion rate. The keys to prevent complication was preoperation evaluation meticulously and a dedicated robotic team to do RALP intraoperatively. Early diagnosis and management of complication is paramount in patients have any deviation from the normal postoperative course and clinical care pathway