Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy.

Tytuł:: Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy.
Autorzy:: Garbens A; Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. J8. 112C, Dallas, TX, 75390, USA.
Lay AH; North Texas VA Medical Center, Dallas, TX, USA.
Steinberg RL; Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. J8. 112C, Dallas, TX, 75390, USA.
Gahan JC; Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. J8. 112C, Dallas, TX, 75390, USA. .; North Texas VA Medical Center, Dallas, TX, USA. .
Źródło:: Journal of robotic surgery [J Robot Surg] 2021 Aug; Vol. 15 (4), pp. 619-626. Date of Electronic Publication: 2020 Oct 01.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: London : Springer
MeSH Terms:: Laparoscopy*
Prostatic Neoplasms*/surgery
Robotic Surgical Procedures*/methods
Robotics*
Surgeons*
Clinical Competence ; Humans ; Learning Curve ; Male ; Prostatectomy ; Retrospective Studies ; Treatment Outcome
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Contributed Indexing:: Keywords: Bedside assistant; Radical prostatectomy; Robotic surgery; Surgical outcomes
Entry Date(s):: Date Created: 20201001 Date Completed: 20211028 Latest Revision: 20220107
Update Code:: 20240105
DOI:: 10.1007/s11701-020-01146-8
PMID:: 33001368
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Robot-assisted laparoscopic radical prostatectomy (RALP) relies heavily on the bedside assistant (BA). Currently, the relationship between BA experience and surgical outcomes in robotic surgery is not clear. We examined whether bedside assistant experience can significantly affect positive margin rate and peri-operative outcomes for RALP for surgeons within their learning curve. A retrospective cohort study of a single surgeon's peri-operative outcomes during RALP was examined and compared with and without an experienced bedside assistant. Patient demographic data and peri-operative data, margin rate, and length of stay (LOS), were collected and analyzed. Univariate and multivariable analyses were performed to determine if expert BA was a predictor of post-operative outcomes. In total, 170 consecutive cases over three years were analyzed. 111 (65%) were performed without an expert BA. The two groups were not significantly different with regards patient demographics (p > 0.05). On univariate analysis, having an expert BA was associated with a significantly lower LOS (31 h ± 21 vs. 42 h ± 26, p = 0.004), EBL (296 ml ± 180 vs. 441 ml ± 305, p < 0.0001) and positive margin rate (20% vs. 37%, p = 0.03). Other surgical outcomes were comparable between groups. On multivariable analysis, expert BA remained a predictor of, EBL (B stat = - 146, 95% CI - 240 to - 52, p = 0.003) and positive margin rate (OR 0.4, 95% CI 0.2-0.96, p = 0.04). Our results demonstrate that the use of an expert BA may result in improved patient outcomes early in the learning curve of RALP, most notably, positive margin rate and estimated blood loss.
(© 2020. Springer-Verlag London Ltd., part of Springer Nature.)

Comment in: J Urol. 2022 Jan;207(1):210-211. (PMID: 34633209)

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