Background/Objectives: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon. The aim of our study was to compare surgical and perioperative outcomes of RARP performed using our alternative trocar placement with no fourth robotic arm in the subgroups of experienced attending surgeons and post-graduate residents as bedside assistants. Residents’ satisfaction was also explored.Methods: RARPs performed within the urology residency program between 2019 and 2024 were retrospectively analyzed. Only rob procedures performed using our 3+2 trocars configuration were included. Intra- and postoperative outcomes, as well as long-term functional outcomes including continence recovery and potency, were assessed, stratified by the level of expertise of the bedside assistant, i.e., an experienced attending or post-graduate Year I–III resident. Satisfaction of residents assigned to the two groups during their robotic rotation was evaluated considering three domains with a score from 1 to 10: insight into surgical procedure, confidence level, and gratification level.Results: Out of n = 281 RARP procedures, the bedside assistant was an attending in 104 cases and a resident in 177. Operative time was found to be slightly longer in cases where the second operator was a resident (attendings vs. residents: 134 ± 40 vs. 152 ± 24;p< 0.001). Postoperative hospitalization time was longer in patients in the resident group (attendings vs. residents: 3.9 ± 1.6 vs. 4.3 ± 1 days;p= 0.025). However, cases where the second operator was a resident had a lower rate of positive surgical margins, with rates of 19.7% in the resident and 43.3% in the attending surgeon cohorts (OR = 0.32; 95% CI 0.18–0.55). This difference remained significant in multivariate analysis. There was no significant difference in postoperative blood transfusion rates (attendings vs. residents: 1.9% vs. 1.2%;p= 0.6). Similarly, long-term functional outcomes in terms of erectile dysfunction and urinary incontinence rates mostly overlapped between groups. The mean score in all three domains evaluating residents’ satisfaction was significantly higher when residents actively participated in the surgical procedure as bedside assistants (p= 0.02,p= 0.004, andp< 0.001, respectively, for insights into surgical procedure, confidence level, and gratification level).Conclusions: These findings provide insight into how an alternative port positioning during RARP could improve the involvement of the bedside assistant, particularly residents, without compromising perioperative outcomes or surgical safety.
背景/目的：机器人辅助根治性前列腺切除术（RARP）用于治疗前列腺癌（PCa）在过去20年中已趋于标准化。本机构仅使用n=3个机器人臂进行RARP。此外，在锁骨中线对称放置n=2个12毫米腹腔镜套管针供床旁助手使用，这种布局实现了直接的盆腔三角操作，并增强了辅助外科医生的参与度。本研究旨在比较采用我们这种替代性套管针布局（不使用第四机器人臂）进行RARP时，由经验丰富的主治医师与毕业后住院医师担任床旁助手两种亚组的手术及围手术期结果，并探讨住院医师的满意度。 方法：回顾性分析了2019年至2024年间在泌尿外科住院医师培训项目中实施的RARP手术。仅纳入采用我们"3+2"套管针配置的机器人手术。评估了术中和术后结果，以及包括控尿功能恢复和勃起功能在内的长期功能结果，并根据床旁助手的专业水平（即经验丰富的主治医师或毕业后第I–III年住院医师）进行分层。通过三个维度（评分1-10分）评估分配到两组的住院医师在其机器人手术轮转期间的满意度：对手术过程的理解程度、自信心水平和成就感水平。 结果：在n=281例RARP手术中，床旁助手为主治医师的104例，为住院医师的177例。当第二术者为住院医师时，手术时间略长（主治医师组 vs. 住院医师组：134 ± 40分钟 vs. 152 ± 24分钟；p < 0.001）。住院医师组患者的术后住院时间更长（主治医师组 vs. 住院医师组：3.9 ± 1.6天 vs. 4.3 ± 1天；p = 0.025）。然而，第二术者为住院医师的手术，其切缘阳性率较低，住院医师组为19.7%，主治医师组为43.3%（OR = 0.32；95% CI 0.18–0.55）。多变量分析中该差异仍具显著性。术后输血率无显著差异（主治医师组 vs. 住院医师组：1.9% vs. 1.2%；p = 0.6）。同样，在勃起功能障碍和尿失禁发生率方面的长期功能结果两组基本重叠。当住院医师作为床旁助手积极参与手术过程时，评估其满意度的所有三个维度的平均得分均显著更高（分别针对手术过程理解、自信心水平和成就感水平，p = 0.02, p = 0.004, 和 p < 0.001）。 结论：这些发现揭示了RARP术中采用替代性套管针布局如何能在不影响围手术期结果或手术安全性的前提下，提高床旁助手（特别是住院医师）的参与度。
肿瘤(癌症)患者之家