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 OBJECTIVESTo report the complications of 1000 cases of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon in Taiwan.
METHODSComplication (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.
RESULTSSignificantly 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%).
CONCLUSIONSLearning 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
    位置
    資料夾名稱
    摘要
    發表人
    TUA秘書處
    單位
    台灣泌尿科醫學會
    標籤
    口頭報告
    建立
    2015-06-01 14:37:00
    最近修訂
    2015-06-01 14:38:21
    瀏覽
    1,443
    more