臨床泌尿器科67巻5号

2013年04月発行

特集 ロボット支援前立腺全摘除術

各論①　ロボット支援前立腺全摘除術におけるラーニング・カーブ―ラーニング・カーブ短縮の焦点とは

著者： 植田健¹ 齋藤允孝¹ 小林将行¹ 小丸淳¹ 深沢賢¹

所属機関： ¹千葉県がんセンター前立腺センター・泌尿器科

ページ範囲：P.299 - P.304

文献概要

要旨　この10年で前立腺全摘術は大きな転換期を迎えた。da Vinciサージカルシステム^®の開発により，欧米では手術症例の85％以上がロボット支援手術（以下，RALP）へ移行した。術者は3次元拡大視野のもとに直観的な手術操作が可能であり，欧米の報告では制癌効果や排尿および性機能の回復も良好とされる。日本では2012年4月からRALPが保険診療として認められた。RALP導入にあたり初期から手技が安定するまでの期間にどのように対応してゆくべきかは重要である。本稿では，ラーニング・カーブ短縮のポイントを自験例を交えて報告する。

参考文献

1）Reiner WG and Walsh PC：An anatomical approach to the surgical management of the dorsal vein and Santorini's plexus during radical retropubic surgery. J Urol 121：198-200, 1979

2）Walsh PC：Anatomic radical prostatectomy：evolution of the surgical technique. J Urol 160：2418-2424, 1998

3）Binder J and Kramer W：Robotically assisted laparoscopic radical prostatectomy. BJU Int 87：408-410, 2001

4）Menon M, Shrivastava A, Tewari A, et al：Laparoscopic and robot assisted radical prostatectomy：establishment of a structured program and preliminary analysis of outcomes. J Urol 168：945-949, 2002

5）Vickers AJ, Bianco FJ, Serio AM, et al：The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst 99：1171-1177, 2007

6）Vickers AJ, Savage CJ, Hruza M, et al：The surgical learning curve for laparoscopic radical prostatectomy：a retrospective cohort study. Lancet Oncol 10：475-480, 2009

7）Bianco JFJ, Riedel ER, Begg CB, et al：Variations among high volume surgeons in the rate of complications after radical prostatectomy：further evidence that technique matters. J Urol 173：2099-2103, 2005

8）Patel VR, Tully AS, Holmes R, et al：Robotic radical prostatectomy in the community setting：the learning curve and beyond：initial 200 cases. J Urol 174：269-272, 2005

9）Atug F, Castle EP, Srivastav SK, et al：Positive surgical margins in robotic-assisted radical prostatectomy：impact of learning curve on oncologic outcomes. Eur Urol 49：866-871, 2006

10）Ahlering TE, Skarecky D, Lee D, et al：Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface：initial experience with laparoscopic radical prostatectomy. J Urol 170：1738-1741, 2003

11）Herrell SD and Smith JA Jr：Robotic-assisted laparoscopic prostatectomy：what is the learning curve? Urol 66：105-107, 2005

12）Ou YC, Yang CR, Wang J, et al：Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by a single surgeon. Asian J Surg 34：74-80, 2011

13）Bouchier-Hayes DM, Clancy KX, Canavan K, et al：Initial consecutive 125 cases of robotic assis-ted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre. Ir J Med Sci 181：21-25, 2012

14）Gumus E, Boylu U, Turan T, et al：The learning curve of robot-assisted radical prostatectomy. J Endourol 25：1633-1637, 2011

15）Trabulsi EJ, Zola JC, Gomella LG, et al：Transition from pure laparoscopic to robotic-assisted radical prostatectomy：a single surgeon institutional evolution. Urol Oncol 28：81-85, 2010

16）Zorn KC, Orvieto MA, Gong EM, et al：Robotic radical prostatectomy learning curve of a fellow-ship-trained laparoscopic surgeon. J Endourol 21：441-447, 2007

17）Jaffe J, Castellucci S, Cathelineau X, et al：Robot-assisted laparoscopic prostatectomy：a single-institutions learning curve. Urol 73：127-133, 2009

18）Coelho RF, Palmer KJ, Rocco B, et al：Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies：report applying a standardized grading system. Eur Urol 57：945-952, 2010

19）Freire MP, Choi WW, Lei Y, et al：Overcoming the learning curve for robotic-assisted laparoscopic radical prostatectomy. Urol Clin North Am 37：37-47, 2010

20）Stolzenburg JU, Qazi HA, Holze S, et al：Evaluating the learning curve of experienced laparoscopic surgeons in robot-assisted radical prostatectomy. J Endourol 27：80-85, 2013

21）Ou YC, Yang CR, Wang J, et al：The learning curve for reducing complications of robotic-assisted laparoscopic radical prostatectomy by a single surgeon. BJU Int 108：420-425, 2011

22）Dindo D, Demartines N and Clavien PA：Classification of surgical complications：a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240：205-213, 2004

23）Maddox M, Lasser MS, Renzulli J, et al：An updated report on complications following robotic prostatectomy：results of an unbiased prospective database. J Endourol. 2012 Oct 15.［Epub ahead of print］

24）Sharma NL, Papadopoulos A, Lee D, et al：First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre：learning curves of two surgeons. BJU Int 108：739-747, 2011

25）Zorn KC, Wille MA, Thong AE, et al：Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. Can J Urol 16：4742-4749, 2009