Predictors of trainees' proficiency during the learning curve of robot-assisted radical prostatectomy at high- -volume institutions: results from a multicentric series.

IF 1.4 Q3 UROLOGY & NEPHROLOGY Central European Journal of Urology Pub Date : 2023-01-01 DOI:10.5173/ceju.2023.260
Umberto Anceschi, Michele Morelli, Rocco Simone Flammia, Aldo Brassetti, Paolo Dell'Oglio, Antonio Galfano, Stefano Tappero, Enrico Vecchio, Marco Martiriggiano, Lorenzo Giuseppe Luciani, Isabella Sperduti, Simone Albisinni, Gabriele Tuderti, Francesco Prata, Maria Consiglia Ferriero, Alfredo Maria Bove, Riccardo Mastroianni, Giuseppe Spadaro, Andrea Russo, Daniele Mattevi, Antonio Tufano, Costantino Leonardo, Riccardo Lombardo, Cosimo De Nunzio, Tommaso Cai, Thierry Quackels, Aldo Massimo Bocciardi, Giuseppe Simone
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引用次数: 2

Abstract

Introduction: The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers.

Material and methods: Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant.

Results: Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15-8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3).

Conclusions: Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes.

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在高容量机构中,机器人辅助根治性前列腺切除术学习曲线中受训人员熟练程度的预测因素:来自多中心系列的结果。
简介:本系列研究的目的是评估多中心机器人辅助根治性前列腺切除术(RARP)的熟练程度评分(PS)的预测因素,这些手术由四家三级医疗中心的实习外科医生采用两种不同的手术技术进行。材料和方法:合并4个机构数据集,查询2010年至2020年期间外科医生在学习曲线(LC)期间使用两种不同方法进行的RARP (A组,Retzius-sparing RARP, n = 164;B组为标准逆行RARP组,n = 79)。进行逻辑回归分析,以确定整个受训队列的PS成就的预测因素。对于所有分析,双侧p结果:B组显示显著增加中位手术时间,阳性手术切缘(PSM)状态,增加神经保留手术次数,缩短LC时间(各p 0.3)。在多变量分析中,LC开始时间≥12个月(OR = 2.79;集成电路(1.15 - -6.76)95%;p = 0.02)和神经保护意图(OR = 3.18;集成电路(1.15 - -8.77)95%;p = 0.02)是PS评分实现的独立预测因子(表3)。结论:从LC开始12个月后,RARP受训者的PS率可能会更高。短期培训课程不太可能提供适当的手术培训,而长期的结构化培训计划似乎有利于围手术期的结果。
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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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