کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3927973 1253192 2010 12 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی زنان، زایمان و بهداشت زنان
پیش نمایش صفحه اول مقاله
Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications
چکیده انگلیسی

ContextRobot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP.ObjectiveThe primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach.Evidence acquisitionA Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper.Evidence synthesisRALP has the following principal downsides: (1) device failure occurs in 0.2–0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology.ConclusionsMany of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: European Urology - Volume 57, Issue 5, May 2010, Pages 735–746
نویسندگان
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