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Perioperatieve, oncologische en functionele leercurves van robotgeassisteerde laparoscopische radicale prostatectomie (RALP) in een hoogvolumeziekenhuis

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Samenvatting

Doelstelling

Analyse van perioperatieve, oncologische en functionele leercurves van robotgeassisteerde laparoscopische radicale prostatectomie (RALP) in een hoogvolumeziekenhuis.

Methoden

Prospectieve dataverzameling van 416 patiënten die een laparoscopische radicale prostatectomie (RALP) ondergingen tussen januari 2009 en maart 2011 in ons ziekenhuis, uitgevoerd door 1 operateur. Follow-up van een jaar met gevalideerde vragenlijsten.

Resultaten

De gemiddelde consoletijd was 129 minuten, bloedverlies 321 ml, opnameduur 3,6 dagen en katheterisatieduur 7,7 dagen. Bij 8% van de patiënten trad een complicatie op. Een positief snijvlak werd bij 16% gezien (12% in de pT2- en 28% in de pT3-groep). Bij 88% werd geen PSA-recidief vastgesteld (92% in de pT2- en 76% in de pT3-groep). 87% van de patiënten was continent, 54% potent, 76% bereikte bifecta en 54% trifecta. Consoletijd, opnameduur, erectiele functie en positieve snijvlakken lieten een gunstige trend zien bij het toenemen van het aantal geopereerde patiënten.

Conclusie

RALP is een veilige ingreep, maar met een leercurve die langer is dan vaak wordt aangenomen. Na circa 200 procedures dalen de positieve snijvlakken significant tot onder de 10% in de pT2-groep. Er is een significant dalende trend waarneembaar van de consoletijd en opnameduur. Er is een positieve trend waarneembaar in herstel van erectiele functie. Operateurs hebben de verantwoordelijkheid realistische verwachtingen te schetsen, gebaseerd op de resultaten die zijn behaald in de eigen serie verrichtingen.

Summary

Peroperative, oncological, functional learning curves of robot assisted laparoscopic radical prostatectomy (RALP) in a high volume hospital

Objective

Analysis of per-operative, oncological and functional learning curves of robot assisted laparoscopic radical prostatectomy (RALP) in a high volume hospital.

Methods

Prospective data collection of 416 patients who underwent a RALP between January 2009 and March 2011 in our hospital, performed by one single surgeon. One year follow-up with validated questionnaires.

Results

The average consoletime was 129 minutes, bloodloss 321 mls, hospital stay 3,6 days and catheterisation time 7,7 days. Complications occurred in 8% of patients. Positive surgical margin rate was 16% (12% in pT2 and 28% in pT3 group). There was no PSA recurrence in 88% (92% in pT2 and 76% in pT3 group). Percentage of continence was 87%, erection 54%, bifecta 76% and trifecta 54%. Consoletime, hospital stay, erection and positive surgical margins showed a beneficial trend when the number of operated patients increased.

Conclusion

RALP is a safe intervention with longer learning curve then previously assumed. After approximately 200 procedures, positive surgical margin rates decrease significantly below 10% in the pT2 group. A significantly descending trend is observed with regard to consoletime and hospital stay. A positive trend is visible regarding erection recovery. Surgeons have the responsibility to render realistic expectations of outcome to patients, based on their own data.

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Author information

Authors and Affiliations

  1. Afdeling Urologie, Maasstad Ziekenhuis, Rotterdam, The Netherlands

    E.R.P. Collette,  D. van den Ouden,  R.P. Engel &  O.S. Klaver

  2. Afdeling Pathologie, Maasstad Ziekenhuis, Rotterdam, The Netherlands

    M. Kliffen

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  1. E.R.P. Collette
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  2. M. Kliffen
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  3. D. van den Ouden
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  4. R.P. Engel
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  5. O.S. Klaver
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Correspondence to E.R.P. Collette.

Additional information

drs. E.R.P. Collette, aios urologie, afdeling Urologie dr. M. Kliffen, patholoog, afdeling Pathologie dr. D. van den Ouden, uroloog, afdeling Urologie drs. R.P. Engel, uroloog, afdeling Urologie drs. O.S. Klaver, uroloog, afdeling Urologie Alle auteurs zijn werkzaam in het Maasstad Ziekenhuis, Rotterdam.

Correspondentie eelco@collette.nl

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Collette, E., Kliffen, M., van den Ouden, D. et al. Perioperatieve, oncologische en functionele leercurves van robotgeassisteerde laparoscopische radicale prostatectomie (RALP) in een hoogvolumeziekenhuis. Tijdschrift voor Urologie 3, 190–200 (2013). https://doi.org/10.1007/s13629-013-0112-y

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