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Cirurgia robótica: uma comparação entre prostatectomia laparoscópica assistida por robô e prostatectomia radical laparoscópica
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RESUMO - Introdução: Atualmente, existe uma acérrima discussão no seio da comunidade
científica sobre as evidências, a eficiência e o potencial impacto inovador que a Cirurgia
Robótica (CR) possui para obter melhorias clínicas transformadoras. É pertinente um
estudo que possa contribuir com algumas conclusões sobre a eficiência desta tecnologia
que tanta polémica tem gerado, ainda mais, num panorama de rescaldo de crise
pandémica que vivemos, onde os recursos, mais do que nunca, são escassos e têm de
ser distribuídos baseados em evidência científica. Assim esta dissertação de Mestrado
tem o objetivo de caracterizar e comparar a Demora Média (DM) da Prostatectomia
Laparoscópica Assistida por Robô (PLAR) e da Prostatectomia Radical Laparoscópica
(PRL), mais especificamente no contexto do Serviço Nacional de Saúde (SNS)
Português. Metodologia: Estudo observacional retrospetivo. Análise estatística
multivariada, que englobou estatística descritiva, o Teste T student, análise de
regressão linear múltipla para o ajustamento para os diagnósticos secundários e a DM
logaritimizada. Resultados/Discussão: Amostra de 199 doentes submetidos a
prostatectomia radical entre 2018-2021 no Centro Hospitalar Universitário de Lisboa
Central (CHULC), sendo que 94 foram submetidos a PLAR e 105 a PRL. O grupo PRL
tem uma média de idades de 69 anos e o grupo PLAR de 67 anos. Ambos os grupos
apresentam uma média do Risco Anestésico ASA de 2, assim como uma classificação
de Severidade idêntica. Toda a amostra tem como diagnóstico principal a Neoplasia
Maligna da Próstata. O grupo PLAR apresenta valores de diagnósticos secundários
ligeiramente superiores aos do grupo PRL. A análise de regressão linear múltipla para
um ajustamento para os diagnósticos secundários demonstra a homogeneidade da
amostra, revelando que, independentemente da distribuição dos mesmos nos 2 grupos,
existe significância estatística na variável dependente: DM (p<0,001). A morada de
residência dos doentes situa-se fundamentalmente na área metropolitana de Lisboa,
com um valor de 83,5%. Os concelhos de Lisboa (38,2%) e de Loures (17,6%) são os
mais representativos. Não existem diferenças significativas entre os grupos PRL e
PLAR. Conclusões: Os resultados são semelhantes aos encontrados na literatura. Na
amostra estudada a DM, tem um valor de 4,49 dias para a PRL e de 3,37 dias para a
PLAR. A diferença de médias dos grupos PLAR-PRL é de -1,113 dias. Assim, com um
intervalo de confiança de 95% é possível afirmar que a PLAR reduz a DM em 1,113 dias
relativamente à PRL (p<0,001). A DM logaritimizada demonstra que a PLAR reduz a DM
em 22% relativamente à PRL (p<0,001).
ABSTRACT - Introduction: Currently, there is a fierce discussion within the scientific community about the evidence, efficiency and potential innovative impact that Robotic Surgery (RC) owns, to achieve transformative clinical improvements. A study that can contribute to some conclusions about the efficiency of this technology that has generated so much controversy is pertinent, even more, in a panorama of the aftermath of the pandemic crisis we are experiencing, where resources, more than ever, are scarce and must be distributed based on scientific evidence. Thus, this master’s thesis aims to characterize and compare the Length of Stay (LOS) of Robot-Assisted Laparoscopic Prostatectomy (RALP) and Laparoscopic Radical Prostatectomy (LRP), more specifically in the context of the Portuguese National Health Service (NHS). Methodology: Retrospective observational study. Multivariate statistical analysis, which included descriptive statistics, Student T test, multiple linear regression analysis for adjustment for secondary diagnoses and logarithmized LOS. Results/Discussion: Sample of 199 patients who underwent radical prostatectomy between 2018-2021 at the Centro Hospitalar Universitário de Lisboa Central (CHULC), 94 were submitted to RALP and 105 to LRP. The LRP group has a mean age of 69 years and the RALP group 67 years. Both groups have a mean Anesthetic Risk of 2, as well as an identical severity rating. The entire sample has as its main diagnosis the Malignant Prostate Neoplasm. The RALP group has slightly higher secondary diagnostic values than the LRP group. The multiple linear regression analysis for an adjustment for secondary diagnoses demonstrates the homogeneity of the sample, revealing that regardless of their distribution in the 2 groups, there is statistical significance in the dependent variable: LOS (p<0.001). The residence address of patients is mainly located in the metropolitan area of Lisbon, with a value of 83.5%. The municipalities of Lisbon (38.2%) and Loures (17.6%) are the most representative. There are no significant differences between both groups. Conclusions: The results are similar to those found in the literature. In the studied sample, LOS has a value of 4.49 days for LRP and 3.37 days for RALP. The difference in means is -1.113 days. Thus, with a 95% confidence interval, it is possible to state that RALP reduces LOS by 1.113 days compared to LRP (p<0.001). Logarithmized LOS demonstrates that RALP reduces Length of Stay by 22% compared to LRP (p<0.001).
ABSTRACT - Introduction: Currently, there is a fierce discussion within the scientific community about the evidence, efficiency and potential innovative impact that Robotic Surgery (RC) owns, to achieve transformative clinical improvements. A study that can contribute to some conclusions about the efficiency of this technology that has generated so much controversy is pertinent, even more, in a panorama of the aftermath of the pandemic crisis we are experiencing, where resources, more than ever, are scarce and must be distributed based on scientific evidence. Thus, this master’s thesis aims to characterize and compare the Length of Stay (LOS) of Robot-Assisted Laparoscopic Prostatectomy (RALP) and Laparoscopic Radical Prostatectomy (LRP), more specifically in the context of the Portuguese National Health Service (NHS). Methodology: Retrospective observational study. Multivariate statistical analysis, which included descriptive statistics, Student T test, multiple linear regression analysis for adjustment for secondary diagnoses and logarithmized LOS. Results/Discussion: Sample of 199 patients who underwent radical prostatectomy between 2018-2021 at the Centro Hospitalar Universitário de Lisboa Central (CHULC), 94 were submitted to RALP and 105 to LRP. The LRP group has a mean age of 69 years and the RALP group 67 years. Both groups have a mean Anesthetic Risk of 2, as well as an identical severity rating. The entire sample has as its main diagnosis the Malignant Prostate Neoplasm. The RALP group has slightly higher secondary diagnostic values than the LRP group. The multiple linear regression analysis for an adjustment for secondary diagnoses demonstrates the homogeneity of the sample, revealing that regardless of their distribution in the 2 groups, there is statistical significance in the dependent variable: LOS (p<0.001). The residence address of patients is mainly located in the metropolitan area of Lisbon, with a value of 83.5%. The municipalities of Lisbon (38.2%) and Loures (17.6%) are the most representative. There are no significant differences between both groups. Conclusions: The results are similar to those found in the literature. In the studied sample, LOS has a value of 4.49 days for LRP and 3.37 days for RALP. The difference in means is -1.113 days. Thus, with a 95% confidence interval, it is possible to state that RALP reduces LOS by 1.113 days compared to LRP (p<0.001). Logarithmized LOS demonstrates that RALP reduces Length of Stay by 22% compared to LRP (p<0.001).
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Prostatectomia laparoscópica assistida por robô Prostatectomia radical laparoscópica Demora média Cirurgia robótica Serviço Nacional de Saúde Centro Hospitalar Universitário de Lisboa Central Robot-Assisted Laparoscopic Prostatectomy Laparoscopic Radical Prostatectomy Length of stay Robotic surgery National Health Service