PD12-07 THE ANALYSIS OF CONSTITUTIONAL TEAM-BASED IMPLEMENTATION OF ROBOTIC SURGERIES

Abstract

INTRODUCTION AND OBJECTIVES: The number of robotassisted radical prostatectomy (RARP) in Japan is increasing rapidly due to the application of health insurance to robotic surgery for prostate cancer since April, 2012. To maintain patient safety and high quality of surgery, the implementation of robotic surgeries in our institution were controlled by the minimal invasive surgery center (MISC), which runs robotic surgeries comprehensively. We report our experience of treating patients in MISC together with outcome of RARP. METHODS: The MISC consisted of all the departments related to robotic surgery including anesthesiology, five surgery departments, operation room nurses and medical engineers. From the view of safe implementation of robotic surgery, a certificate for surgery type and the console surgeon were authorized by MISC. Specifically, the MISC has a 0termination order0 authority, which is applied when there is excessive bleeding or surgical time. Robotic surgery must be changed into other types of surgery such as open conversion once the order is given. Each robotic surgery case in five surgery departments is checked and discussed preand post-operatively in the regular meeting held by MISC twice a month. RESULTS: The case number results stratified by robotic surgery types in the MISC over the last 2 years are shown in Table. The Urology, gynecology, respiratory surgery, digestive surgery and otorhinolaryngology departments performed 176, 22, 43, 34 and 2 cases of robotic surgeries, respectively. The number of cases with major complications including Clavien 5, 4 and 3 in all 277 cases were 0, 0 and 6 (2.2 %), respectively with one case of intra-operative open conversion. The core of robotic surgeries in MISC was RARP, and the implementation of this surgery based on the concept of pentafecta was supervised by MISC. At the median follow-up time of 11.9 (range 1.3 27.3) months, the positive surgical margin rate was 15.8 %, 91% of patients had undetectable PSA levels, and 76% of patients were not using pads. CONCLUSIONS: This is the first report of robotic surgery cases that were implemented using the constitutional framework of an academic institution. The MISC is providing immeasurable benefits from the aspects of patient safety and education for the robotic surgical team, and ultimately lead to accomplishment of pentafecta of RARP in urology.