RESUMEN
The benefits and outcomes of robotic surgery are well established in the literature across multiple specialties. The increasing need for and dissemination of this technology associated with high costs, demand adequate planning during its implementation. Therefore, after years of training several robotic surgeons and establishing multiple robotic programs worldwide, the purpose of this article is to focus on the necessary elements in the initial phase of establishing a robotics program. We summarized in our article crucial factors when implementing a robotic program. Therefore, we explained in detail the critical aspects of the program design, implementation, marketing, research and outcomes, and ultimately improving efficiency. The creation of a robotics planning committee composed of several hospital individuals contributes in different lines of work such as cost evaluation, staff training, and OR modifications. A multidisciplinary approach and a robotic lead surgeon are also recommended to guarantee surgical volume and satisfactory outcomes. Furthermore, market analysis should evaluate the competition with other centres and potential surgical candidates in that area. Data collection should also be considered a vital element of the program organization, which assures quality control and helps to diagnose any program deficiency. We believe that the robotic program should be individualized according to the economy and reality of each centre. The success and duration of a robotic surgery program depend on long-term results. Therefore, careful planning with a robotic committee defining the types of procedures to be performed and appropriate multidisciplinary training to avoid surgery cancelations are crucial factors in establishing a successful program.
Asunto(s)
Eficiencia Organizacional , Eficiencia , Quirófanos , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Procedimientos Quirúrgicos Robotizados , Arquitectura y Construcción de Instituciones de Salud , Humanos , Laparoscopía , Comercialización de los Servicios de Salud , Grupo de Atención al Paciente , Procedimientos Quirúrgicos Robotizados/economía , Procedimientos Quirúrgicos Robotizados/educación , Procedimientos Quirúrgicos Robotizados/tendenciasRESUMEN
PURPOSE: Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles. RESULTS: Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. CONCLUSIONS: The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.
Asunto(s)
Laparoscopía/métodos , Erección Peniana/fisiología , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Robótica/métodos , Disfunción Eréctil/prevención & control , Humanos , Masculino , Pene/inervación , Próstata/inervación , Resultado del TratamientoRESUMEN
PURPOSE: Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: We performed a MEDLINE search from 2001 to 2009 using the keywords robotic prostatectomy, cavernosal nerve, pelvic neuroanatomy, potency, outcomes and comparison. Extended search was also performed using the references from these articles. RESULTS: Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, the veil of Aphrodite, athermal retrograde neurovascular release, clipless antegrade nerve sparing and clipless cautery free technique. The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. CONCLUSIONS: The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.