Abstract:
OBJECTIVE:To evaluate the effect of the learning curve on operative, postoperative, and pathological outcomes of the first 67 totally intracorporeal robot-assisted radical cystectomies (RARCs) with neobladders performed by two lead surgeons at Karolinska University Hospital. PATIENTS AND METHODS:Between December 2003 and October 2012, 67 patients (61 men and six women) underwent RARC with orthotopic urinary diversion by two main surgeons. Data were collected prospectively on patient demographics, peri- and postoperative outcomes including operation times, conversion rates, blood loss, complication rates, pathological data and length of stay (LOS) for these 67 consecutive patients. The two surgeons operated on 47 and 20 patients, respectively. The patients were divided into sequential groups of 10 in each individual surgeon's series and assessed for effect of the learning curve. RESULTS:Patient demographics and clinical characteristics were similar in both surgeons' groups. The overall total operation times trended down in both surgeons' series from a median time of 565 min in the first group of 10 cases, to a median of 345 min in the last group for surgeon A (P < 0.001) and 413 to 385 min for surgeon B (not statistically significant). Risk of conversion to open surgery also decreased with a 30% conversion rate in the first group to zero in latter groups (P < 0.01). Overall complications decreased as the learning curve progressed from 70% in the first group to 30% in the later groups (P < 0.05), although major complications were not statistically different when compared between the groups. Patient demographics did not change over time. The mean estimated blood loss was unchanged across groups with increasing experience. The pathological staging, mean total lymph node yield and number of positive margins were also unchanged across groups. There was a decrease in LOS from a mean of 19 days in the first group to a mean (range) of 9 (4-78) days in the later groups, although the median LOS was unchanged and therefore not statistically significant. CONCLUSIONS:Totally intracorporeal RARC with intracorporeal neobladder is a complex procedure, but it can be performed safely, with a structured approach, at a high-volume established robotic surgery centre without compromising perioperative and pathological outcomes during the learning curve for surgeons. An experienced robotic team and mentor can impact the learning curve of a new surgeon in the same centre resulting in decreased operation times early in their personal series, reducing conversion rates and complication rates.
journal_name
BJU Intjournal_title
BJU internationalauthors
Collins JW,Tyritzis S,Nyberg T,Schumacher MC,Laurin O,Adding C,Jonsson M,Khazaeli D,Steineck G,Wiklund P,Hosseini Adoi
10.1111/bju.12347subject
Has Abstractpub_date
2014-01-01 00:00:00pages
100-7issue
1eissn
1464-4096issn
1464-410Xjournal_volume
113pub_type
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/bju.14873
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To investigate the potential utility of a new combined immunostaining technique for diagnosing prostate cancer from histological analysis of needle biopsy specimens. MATERIALS AND METHODS:Tissue was immunostained with a combination of antibodies against a basal cell marker (p63), and an enzyme commonly overe...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2006.06069.x
更新日期:2006-05-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2007.07046.x
更新日期:2007-10-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1464-410X.2009.08849.x
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:To report a contemporary series of patients with xanthogranulomatous pyelonephritis (XGP, an inflammatory condition of the kidney that has traditionally been treated with open nephrectomy, ON), managed with either ON or laparoscopic nephrectomy (LN), as early reports suggest that the benefits of LN do not ext...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2009.08547.x
更新日期:2009-11-01 00:00:00
abstract:UNLABELLED:WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Erectile dysfunction after nerve-sparing radical retropubic prostatectomy constitutes a challenge to the urologist. The mainstay of medical treatment after radical prostatectomy to restore spontaneous erectile function remains phosphodiesterase (PDE5...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2012.11561.x
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVE:To investigate the incidence of bone fractures in patients receiving luteinizing hormone-releasing hormone agonists (LHRH-a) for prostate cancer (in whom a continued low testosterone level after the long-term administration of these drugs reduces bone mineral density), and thus determine the risk of secondary...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2000.00774.x
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence. PATIENTS AND METHODS:Thirty-four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.1999.00916.x
更新日期:1999-03-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1464-410X.2005.05504.x
更新日期:2005-06-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
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更新日期:2014-01-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章,meta分析,评审
doi:10.1111/bju.13759
更新日期:2017-04-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
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journal_title:BJU international
pub_type: 杂志文章,评审
doi:10.1111/bju.12955
更新日期:2015-10-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2011.10526.x
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:To assess the utility of perceived control over ejaculation ('control') in the evaluation of treatment benefit in men with premature ejaculation (PE), and to compare effects associated with a two-category or greater increase in this variable between men receiving dapoxetine and placebo. PATIENTS AND METHODS...
journal_title:BJU international
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1464-410X.2008.07845.x
更新日期:2008-09-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2008.07513.x
更新日期:2008-05-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/bju.13915
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/bju.14772
更新日期:2019-04-09 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2009.08974.x
更新日期:2010-04-01 00:00:00
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doi:10.1111/j.1464-410X.2005.05329.x
更新日期:2005-03-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-01-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1111/bju.12964
更新日期:2015-04-01 00:00:00
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journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2002.02666.x
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To investigate the effectiveness of a combined treatment of 3-30-methylene-bis[4-hydroxycoumarin] (dicoumarol) with doxorubicin for the treatment of urothelial cancer, as doxorubicin is a common chemotherapeutic agent but its therapeutic efficacy is limited. MATERIALS AND METHODS:The synergistic effect of di...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2009.08732.x
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:To address concerns about the impact of training on patient outcomes during the 'learning curve' for laparoscopic radical prostatectomy (LRP), we compare the results of our patients undergoing LRP with and without trainees performing a substantial proportion of the cases. PATIENTS AND METHODS:In all, 771 con...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2008.08262.x
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To increase the clinical usefulness of the actively deflectable flexible ureteroscope by making sequential changes in design and then using these prototypes clinically; and to develop a clinical series using the optimum prototype and contrast it with an extensive database of patients treated with the traditio...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410x.2004.04567.x
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:To determine whether men with premature ejaculation who fail to respond to 25 mg clomipramine as needed improve when taking 10-30 mg clomipramine daily. SUBJECTS AND METHODS:Four men with premature ejaculation whose ejaculation latencies increased minimally or not at all when taking 25 mg clomipramine as nee...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1046/j.1464-410x.2001.00112.x
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVES:To determine the prevalence of extended-spectrum β-lactamase (ESBL) in patients undergoing transrectal prostate biopsy, to assess the incidence of postoperative sepsis, to correlate the development of sepsis with the presence of preoperative ESBL on rectal swabs, and to assess the adequacy of prophylactic an...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/bju.14745
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To determine the mechanism that underlies the effect of shock wave (SW) rate on the performance of clinical lithotripters. MATERIALS AND METHODS:The effect of firing rate on the pressure characteristics of SWs was assessed using a fibre-optic probe hydrophone (FOPH 500, RP Acoustics, Leutenbach, Germany). Sh...
journal_title:BJU international
pub_type: 杂志文章
doi:10.1111/j.1464-410X.2008.07896.x
更新日期:2008-12-01 00:00:00