歐宴泉、黃立華、翁瑋駿、許兆畬、林益聖、童敏哲

童綜合醫院 外科部 泌尿科

 

Yen Chuan Ou, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Shu, Yi-Sheng Lin, Min-Che Tung

Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan

 

Purpose: The da Vinci robot system has become the mainstay of minimally invasive surgery and has been used in numerous complex reconstructive procedures. There has been an increase in the number of urologic procedures performed robotically assisted, including surgery for prostate, kidney, bladder and others. We attempted to expand indication and broader application of the daVinci robot system into other urologic surgeries from single console surgeon experience.

Materials and Methods: We retrospectively reviewed a total of 683 patients who underwent robotic-assisted urologic surgery between December 2005 and May 2018. We divided this 13-year course into three periods, and analyzed the surgical capability of operations in over different periods through a retrospective analysis. There are the first period (Dec./2005-Dec./2010), the second period (Jan./2011-Dec. 2014), and the third period (Jan./2015-March /2018).Results: We used Logistic regression with backward elimination to select out potential risk factors. According to Harrell’s guidelines, we chose 7 variables in our final model: Age, DRE corresponding MRI, AUR, PSAD, PSAV, PI RADS, and Biopsy pathology. The 95% confidence interval of the original C-index was obtained from 1000 bootstrap resampling. All statistical analyses were performed by using SAS software version 9.4 (SAS Institute INC., Carey, NC) and R (R Core Team 2017). A nomogram prediction adenocarcinoma was developed using data for 130 patients with MRI based on 7 parameters. The original c-index for the nomogram was 0.80 with 95% confidence interval (0.74, 0.89). The average c-index of the 1000 bootstrap resamples was 0.81.

Results: Eight category (28 kinds) of urologic surgeries, including adrenal gland, kidney, ureter, kidney combined ureter, urinary bladder, prostate, kidney combined ureter and urinary bladder and others. Starting with radical prostatectomy in December 2005, following that we performed various types of procedures such as adrenal gland procedures (adrenalectomy and partial adrenalectomy), kidney procedures (heminephrectomy, partial nephrectomy, radical nephrectomy, nephropexy,), ureter procedures (dismembered pyeloplasty, ureteroureterostomy, pyelolithotomy, ureterolithotomy, ureteral reimplantation, ureteroplasty with buccal mucosa, resected endometriosis of ureter with ureteroureterostomy), kidney combined ureter procedures (nephroureterectomy with bladder cuff excision), prostate procedure (radical prostatectomy, theronostic radical prostatectomy, simple prostatectomy, salvage radical prostatectomy and bilateral pelvic lymph node dissection),urinary bladder procedures (partial cystectomy, radical cystoprostatectomy or cystectomy with ileal conduit, radical cystoprostatectomy or with Studer pouch and urinary bladder diverticulectomy), kidney combined ureter and urinary bladder procedures(nephroureterectomy and radical cystectomy, nephroureterectomy and radical cystectoprostatectomy), others(pelvic cyst removal, ventral hernia repair and retroperitoneal tumor resection). Case number increased from 294, 737, and 824 in this three stage. Indication was expended, one disease with 2-3 organs can operation simultaneously. Two or three diseases with two or three organs involvement was operable simultaneously. The incidence of prostate procedure in total procedure was still major operation in three period (84.3%,87.1% and 84.7%).

Based on our experience, a robotic system can be applied to many different types of urologic surgeries both safely and efficiently. Broader application of urological procedure is still going on.