Data di Pubblicazione:
2011
Citazione:
Mentor training and RALP / P. Acquati, C. Simeone, B. Rovereto, M.G. Spinelli, A.A. Grasso, D. Abed El Rahman, A. Antonelli, J. Antolini, L. Gatti, G. Albo, F. Gadda, B. Rocco, S. Cosciani Cunico, F. Rocco. ((Intervento presentato al 84. convegno Congresso nazionale Società italiana di urologia tenutosi a Roma nel 2011.
Abstract:
P64
MENTOR TRAINING AND RALP
Aim of the study
The widespread employment of robotic surgery poses a serious concern
on how to train surgeons, especially those without any laparoscopic background.
To fill the gap many different learning paths are feasible: surgery
fellowship and partnership in specialised centers require long training periods,
whereas mentor training with skilled surgeons is much easier for new
robotic surgeons. The aim of the study is to describe the preliminary experience
in different centers with no laparoscopic skills, where robotic surgery
started with the support of a mentor.
Materials and methods
97 RALP were executed between January 2010 and April 2011 in 3 new robotic
centers (73 Milano, 21 Brescia and 6 Pavia). The selection criteria have
been: organ-confined disease (T1c-T2), prostate ecographic volume <80 gr,
no evidence of third lobe and no need for limphadenectomy following Kattan
nomograms. All procedures were performed by skilled laparotomy surgeons,
supported by the mentor who followed the first 10 robotic prostatectomies
in each center. Surgery was performed with Da Vinci Standard 4 arms in
73 cases and with Da Vinci 4S in 27 cases. The preliminary experience
with mentor was evaluated considering operatory time (skin to skin), intraoperatory
blood loss, mean stay in hospital, mean permanence of vesical
catheter, positive margins and complications (Clavien-Dindo).
Results
Mean operatory time was 381 minutes (range 195-520) with mean intraoperatory
blood loss of 650 ml (range 50-4000) and need for blood transfusion
in 9 patients (9.2%). Mean stay in hospital was 6.3 days (range 2-15)
with mean permanence of vesical catheter of 10 days (range 5-69). Positive
margins were found in 13 out 74 pT2 patients (17.5%) and 9 out of 23 pT3
patients (39.1%). 83 patients did not have any intra- or peri-operatory complications
(85.5%), but we registered complications type I in 8 patients, type
II in 3 patients, type III in 2 patients and type IV in one patient (myocardial
infarction with coronary stenting).
Conclusions
In the center where the highest number of mentorized RALP was performed,
we noticed, after the execution of 30 procedures, a fast and impressive reduction
of operatory time, blood loss, hospital stay and catheterisation days.
Therefore mentor training seems a good formative training for surgeons
approaching robotic procedures.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
P. Acquati, C. Simeone, B. Rovereto, M.G. Spinelli, A.A. Grasso, D. Abed El Rahman, A. Antonelli, J. Antolini, L. Gatti, G. Albo, F. Gadda, B. Rocco, S. Cosciani Cunico, F. Rocco
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