Robotická radikální prostatektomie současný stav

Transcription

1 Robotická radikální prostatektomie současný stav FN Motol Jan Schraml

2 2

3 da Vinci Si HD nebo Sie

4 Centra robotické chirurgie v ČR

5 Aktuální data z ČR k

6 dvpro stat dvkid ney dvvez ikovag. phist dvcys tecto my dvrec tum dvgyn ekolog dvorl ALL

7 dvp v roce 2012 v ČR 7

8 Minimum nástrojů

9 Right neurovascular bundle 9

10 Anastomosis 10

11 Surgery vs. Surgery Výsledky

12 EUROPEAN UROLOGY 61 (2012) available at journal homepage: Platinum Priority Prostate Cancer Editorial by Joshua J. Meeks and James A. Eastham on pp of this issue Perioperative Outcomes of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample Quoc-Dien Trinh a,b,1, *, Jesse Sammon a,1, Maxine Sun b, Praful Ravi c, Khurshid R. Ghani a, Marco Bianchi d, Wooju Jeong a, Shahrokh F. Shariat e, Jens Hansen f, Jan Schmitges f, Claudio Jeldres b, Craig G. Rogers a, James O. Peabody a, Francesco Montorsi d, Mani Menon a, Pierre I. Karakiewicz b 12

13 Table 3 Perioperative outcomes during initial hospitalization following radical prostatectomy, stratified by open or robotic surgical approach Open, n = 7389 Robotic, n = Robotic vs open, odds ratio (95% CI) p value Homologous blood transfusion, n (%) 572 (7.7) 232 (2.0) 0.24 ( ) <0.001 Intraoperative complication, n (%) 73 (1.0) 43 (0.4) 0.36 ( ) <0.001 Postoperative complication, * n (%) Overall 823 (11.1) 975 (8.2) 0.71 ( ) <0.001 Cardiac 96 (1.3) 106 (0.9) 0.68 ( ) Respiratory 191 (2.6) 140 (1.2) 0.45 ( ) <0.001 Vascular 45 (0.6) 44 (0.4) 0.61 ( ) Operative wound 48 (0.6) 50 (0.4) 0.65 ( ) Genitourinary 86 (1.2) 121 (1.0) 0.87 ( ) Miscellaneous medical 459 (6.2) 584 (4.9) 0.78 ( ) <0.001 Miscellaneous surgical 121 (1.6) 166 (1.4) 0.85 ( ) Length of stay >2 d, n (%) 2923 (39.6) 1529 (12.9) 0.23 ( ) <0.001 In-hospital mortality, n (%) 6 (0.1) 1 (0.0) 0.10 ( ) CI = confidence interval. * Rates of complication are not additive, as patients may have had multiple complications. 13

14 Conclusion In a broadly representative sample of patients undergoing RP in the United States, RARP has supplanted ORP as the most common surgical treatment of PCa. Superior perioperative outcomes were seen after RARP in virtually all of the examined outcomes, namely, blood transfusions, intraoperative and postoperative complications, and plos. 14

15 BJUI BJU INTERNATIONAL Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon Vipul R. Patel*, Rafael F. Coelho*, Sanket Chauhan*, Marcelo A. Orvieto*, Kenneth J. Palmer*, Bernardo Rocco*, Anathakrishnan Sivaraman* and Geoff Coughlin* *Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Celebration, FL, USA, Divisão de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Divisione di Urologia Istituto Europeo di Oncologia, Milan, Italy Accepted for publication 10 May

16 TABLE 2 PSM rates stratified by age Age group, years PSM rate Overall >65 P n/n (%): Overall 42/404 (10.64) 13/142 (9.1) 18/168 (10.7) 11/94 (11.7) pt2 26/366 (7.0) 9/131 (6.8) 11/152 (7.2) 6/83 (7.2) pt3 16/38 (42) 4/11 7/16 5/

17 Current Conclusions