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首页> 外文期刊>European urology >Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function
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Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function

机译：在机器人辅助根治性前列腺切除术中减轻神经衰弱以改善性功能的技术改进和学习曲线

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Background: While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes. Objective: Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP). Design, setting, and participants: We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction. Surgical procedure: Our approach to RARP has been described previously. A single-console robotic system was used for all cases. Outcome measurements and statistical analysis: Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function. Results and limitations: Greater surgeon experience was associated with better 5-mo sexual function (p = 0.007) and a trend for better 12-mo sexual function (p = 0.061), with improvement plateauing after 250-300 cases. Additionally, younger patient age (both p < 0.02) and better preoperative sexual function (<0.001) were associated with better 5- and 12-mo sexual function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p = 0.021), while unilateral nerve sparingon-nerve sparing was associated with worse 5-mo sexual function (p = 0.009). Limitations include the retrospective single-surgeon design. Conclusions: With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement.
机译：背景：尽管前列腺癌根治术的外科医生学习曲线具有失血少，手术时间短和阳性切缘少的特点，但缺乏研究曲线可以改善性功能。此外，尽管学习曲线研究通常定义了改进的阈值，但这些研究中很少有研究表明特定的技术改进可以使改进结果具有可重复性。目的：基于技术改进，减少并保留神经保护性机器人辅助根治性前列腺切除术（RARP）期间的神经血管束移位，以演示并量化学习曲线，以改善性功能结果。设计，环境和参与者：我们进行了一项回顾性研究，对400连续RARPs（分为50组）进行了回顾性研究，消除了连续的外科医生/辅助神经血管束反冲。手术过程：前面已经描述了我们的RARP方法。在所有情况下均使用单控制台机器人系统。结果测量和统计分析：前列腺癌指数扩大在RARP的1年内测量了复合性功能。进行线性回归以确定影响性功能恢复的因素。结果与局限性：外科医生经验的增加与5个月性功能改善（p = 0.007）和12个月性功能改善的趋势（p = 0.061）有关，250-300例患者的平稳性改善。此外，患者年龄越小（p <0.02）和术前性功能更好（<0.001）与5个月和12个月性功能更好相关。此外，受训机器人在保留神经期间的控制台操作时间与12个月性功能较差有关（p = 0.021），而单侧神经保留/非神经保留与5个月性功能较差有关（p = 0.009）。局限性包括回顾性单外科医生设计。结论：随着外科医生经验的增加，减轻神经血管束的横向移位以及由此产生的神经性贫血改善了术后的性功能。但是，为了最大程度地提高结果，在允许受训者保留神经时，必须进行适当的患者选择。

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