Evolución de la cirugía abierta versus laparoscópica/robótica: 10 años de cambios en Urología |
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| Authors: | JA Peña González M Pascual Queralt JT Salvador Bayarri A Rosales Bordes J Palou Redorta H Villavicencio Mavrich |
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| Institution: | 1. Veteran Affairs Boston Healthcare System, Boston, MA, Estados Unidos;2. San Carlo di Nancy Hospital, Roma, Italia;3. Division of Urology, Department of Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA, Estados Unidos;4. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, Estados Unidos;1. Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España;2. Unidad de Investigación, Hospital Costa del Sol, Marbella, Málaga, España;3. Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, España;1. Ex Directora de la Dirección General de Ordenación y Regulación Sanitarias, Departament de Salut, Generalitat de Catalunya;2. Consejo Consultivo de Pacientes de Cataluña, Departament de Salut, Generalitat de Catalunya;3. Subdirección General de Servicios y Productos Sanitarios, Departament de Salut, Generalitat de Catalunya;4. Directora de la Dirección General de Ordenación y Regulación Sanitarias, Departament de Salut, Generalitat de Catalunya;1. Departamento de Urología, Confederación Americana de Urología, Miami, FL, Estados Unidos;2. Departamento de Urología, Global Robotics Institute, Celebration, FL, Estados Unidos;3. Departamento de Urología, Clínica de Marly, Bogotá, Colombia;4. Departamento de Urología, Institute Mutualiste Montsouris, París, Francia;5. Departamento de Urología, Hospital Universitario de Caracas, Caracas, Venezuela;1. Madigan Army Medical Center, Joint Base Lewis McCord, Tacoma, Washington;2. Brian Allgood Army Community Hospital, Seoul, South Korea;3. William Beaumont Army Medical Center, El Paso, Texas |
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| Abstract: | IntroductionLaparoscopic surgery has been increasingly used in urology in recent years. Laparoscopy has been performed at our center since 2001. Changes over time in the indication of open versus laparoscopic/robotic surgery, hospital stay, and learning curve are reviewed.Materials and methodsA retrospective review of our database from 1997 to the end of 2007. A total of 3622 procedures were performed during this time (endoscopic procedures were excluded): 67,75% open, 26,17% laparoscopic, 2,29% perineal, and 3,78% robotic surgeries. Of these, 83,79% were performed in males and 16,20% in females. Mean patient age was 58,8 years. Data from the study period, including mean hospital stay and changes over time in operating time as a function of the learning curve, were analyzed and compared to data for the last 12 months of the study period.ResultsThe percentages of all surgical procedures performed using a laparoscopic approach in the 1997–2006 versus the last 12 study months were as follows: nephrectomy, 31,8% versus 74,7%; living donor nephrectomy, 93% versus 100%; nephroureterectomy, 28,1% vs. 93,4%; partial nephrectomy, 31,3% vs 87%; and radical prostatectomy, 17,6% versus 73,5% including laparoscopic and robotic approaches. Shorter mean hospital stays and operating times were also seen.ConclusionsUse of the laparoscopic approach has greatly increased in the 10-year period studied. In renal surgery, few indications remain for open surgery. In prostate surgery, introduction of robotic surgery in 2005 and learning of laparoscopy by several of our urologists have dramatically changed the therapeutic approach. Gradual incorporation of laparoscopic surgery has led to a decreased hospital stay and to a shortening of the learning curve. |
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