經腹膜外腹腔鏡攝護腺全切除術之早期學習曲線與預後分析

簡黃鎰、姜秉均、廖俊厚

天主教耕莘醫療財團法人耕莘醫院泌尿科

The early learning curve of extraperitoneal laparoscopic radical prostatectomy and peri-operative outcome analysis

Huang-Yi Chien、Bing-Juin Chiang、Chun-Hou Liao

Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan

Purpose: Analyze the early learning curve for extraperitoneal laparoscopic radical prostatectomy by a single surgeon in a secondary referral hospital.

Materials and Methods: We had performed 38 LRP surgery between April 2014 and August 2020. The patients were consecutively divided into 2 groups of 19 patients for analysis (Group A:19 patients between 2014 and 2018, Group B:19 patients between 2019 and 2020). All surgeries were performed using extraperitoneal laparoscopic technique with 4 trocars by a single surgeon. The prostate volume, prior TURP, length of surgery, intraoperative blood loss, positive margin rate, postoperative incontinence time were determined in 2 groups and compared.

Results: Mean prostate volume was 37.6 gm in group A and 51.5 gm in group B(p=0.02). Mean operative time was 345 mins in groups A and 237 mins in group B(p<0.05). Urethrovesical anastomosis mean time was 88 mins and 60 mins (p<0.05). Mean intraoperative blood loss was 990ml and 682ml (p=0.06). Positive margin rate was 37% and 24% (p=0.4). Mean duration of postoperative incontinence with diaper usage was 3 months and 0.96 months in group A and group B (p=0.02). 2 patients in group A had major complication (ureter injury and hemolock bladder migration).

Conclusion: Operative time and anastomosis suture time significantly decreased and stabilized after first 19 cases. Significantly less postoperative incontinence duration was also achieved after first 19 patients. The major complications occurred in the first 19 cases.