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복강경하 근치적 전립선적출술: 초기 150례의 학습곡선

Laparoscopic Radical Prostatectomy: the Learning Curve of the Initial 150 Cases

대한비뇨기과학회지 2008년 49권 10호 p.879 ~ 885
김선옥 ( Kim Sun-OK ) - 가톨릭대학교 의과대학 비뇨기과학교실

황태곤 ( Hwang Tae-Kon ) - 가톨릭대학교 의과대학 비뇨기과학교실
홍성후 ( Hong Sung-Hoo ) - 가톨릭대학교 의과대학 비뇨기과학교실

Abstract


Purpose: We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients.

Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50(group 1) and last 50(group 3) procedures were compared.

Results: The mean operating time and hospital stay was 289±66 minutes and 6.3±2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days(range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39(33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence.

Conclusions: Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy.

키워드

Prostatic neoplasms;Prostatectomy;Laparoscopy
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