Introduction: Previous studies of robotic-assisted radical prostatectomy (RARP) have suggested that obesity is a risk factor for worse perioperative outcomes. We evaluated whether body mass index (BMI) adversely affected perioperative outcomes. Methods: A prospective database of 153 RARP (single surgeon) was analyzed. Obesity was defined as BMI ≥ 30 kg/m 2 ; normal BMI < 25 kg/m 2 ; and overweight as 25 to 30 kg/m 2 . Two separate analyses were performed: the first 50 cases (the initial learning curve) and the entire cohort of 153 RARP. Results: In the initial cohort of 50 cases (14 obese patients), there was no statistically significant difference with regards to operative times, port-placement times and estimated blood loss (EBL). Length of stay (LOS) was longer in the obese group (4.3 vs. 2.9 days); BMI remained an independent predictor of increased LOS on multivariate linear regression analysis (p = 0.002). There was no statistically significant difference in the postoperative outcomes of leak rates, margin rates and incisional herniae. In the entire cohort, when comparing obese patients to those with a normal BMI, there was no statistically significant difference in operative times, EBL, LOS, or immediate postoperative outcomes. However, on multivariate linear regression analysis, BMI was an independent predictor of increased operative time (p = 0.007). Conclusion: Obese patients do not have an increased risk of blood loss, positive margins or the postoperative complications of incisional hernia and leak during the learning curve. They do, however, have slightly longer operative times; we also noted an increased LOS in our first 50 cases. RésuméIntroduction : Des études antérieures sur la prostatectomie radicale assistée par robot (PRAR) ont laissé entendre que l'obésité était un facteur de risque de complications périopératoires. Nous avons évalué si l'indice de masse corporelle (IMC) affectait de façon négative les résultats de l'opération. Méthodologie : Une base de données prospective comptant 153 PRAR (effectuées par un seul chirurgien) a été analysée. On a défini l'obésité comme un IMC ≥ 30 kg/m 2 , un IMC normal étant < 25 kg/m 2 , et un IMC entre 25 et 30 kg/m 2 représentant un surplus de poids. Deux analyses distinctes ont été réalisées : les 50 premiers cas (courbe d'apprentissage initiale) et la cohorte entière des 153 patients ayant subi une PRAR. Résultats :Dans la cohorte initiale de 50 cas (dont 14 patients obèses), on n'a noté aucune différence significative sur le plan statistique en ce qui concerne la durée de l'opération, le temps requis pour installer l'accès vasculaire et la perte de sang approximative. La durée du séjour était plus longue dans le groupe des patients obèses (4,3 contre 2,9 jours), et l'IMC est demeuré un facteur indépendant de prédiction d'une durée prolongée du séjour lors de l'analyse de régression linéaire multivariée (p = 0,002). Aucune différence significative sur le plan statistique n'a été notée dans les résultats postopératoires quant aux taux de fuite, ...
New surgical teaching methods are continuously being developed to overcome the learning curves of new advanced surgical procedures. The learning curve is recognized in most minimally invasive and robot-assisted surgery. The development of complex skills-training models and simulators, although in its infancy, has started to facilitate the transfer of these skills to novice surgeons without increasing the risk to patients' safety. Robotic surgery, whether in the specialties of urology, general surgery, or cardiac surgery, has become the ideal platform to integrate simulators for teaching purposes. Its different interface requires the surgeon to acquire more advanced skills compared with conventional open or laparoscopic surgery. However, simulators can allow the naïve surgeon to develop these skills and pass the learning curve without the medico-legal implications of surgical training, limitations in trainee working hours, and ethical considerations of learning basic skills on humans.
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