達文西機器人輔助腹腔鏡攝護腺全切除術前六十例之學習曲線

何肇晏¹、黃一勝^1,2、蔡德甫^1,2、葉忠信^1,2、莊光達^1,2、鄭以弘¹、仇光宇^1,2、陳宏恩¹、林宜佳^1,2

1.新光吳火獅紀念醫院外科部泌尿科

2.輔仁大學

Lurning curve of the first 60 cases of robot-assisted radical prostatectomy

Chao-Yen Ho¹, Thomas I.S. Hwang^1,2, Te-Fu Tsai^1,2, Chung-Hsin Yeh^1,2, Guang-Dar Juang^1,2, Yi-Hong Cheng¹, Kuang-Yu Chuo^1,2, Hung-En Chen¹, Yi-Chia Lin^1,2

1.Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taipei, Taiwan

2.Fu-Jen Catholic university, New Taipei, Taiwan

Purpose: We investigate the initial 60 cases of the robot-assisted radical prostatectomy(RARP), and tried to figure out the duration of learning curve of RARP.

Materials and Methods: From June 2014 to April 2016, the initial sixty patients underwent RARP in Shin Kong WHS Memorial Hospital were enrolled. These patients were separated into three groups. Group 1 was the 1^st to 20^th patient, group 2 was the 21^th to 40^th patient, and group 3 was the 41^th to 60^th patient. We analyzed the operative time, estimated blood loss, and the surgical margin status of these cases.

Results: There was significant difference between these three groups. (p<0.05). The operative time, estimated blood loss, and the positive surgical margin were improved every twenty cases as we estimated. The median operative time was 237.5 minutes and the estimated blood loss was 100 ml in Group 3. A high positive surgical margin rates (81.25%) was record in all patients with pT3 disease.

Conclusions: RARP is not a simple procedure to do. The surgical outcome was related to surgeon experience. The learning curve in our results is about 40 cases to make RARP as a safe procedure. However, the learning curve to reduce the positive margin rates in T3 disease may need more practice to optimize the results for patients.