The Learning Curve of Robotic-Assisted Low Rectal Resection of a Novice Rectal Surgeon
The Learning Curve of Robotic-Assisted Low Rectal Resection of a Novice Rectal Surgeon
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DOI：
10.1007/s00268-015-3251-x
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发表时间：
2016-02-01
影响因子：
2.6
通讯作者：
Law, Wai Lun
中科院分区：
文献类型：
--
作者：
Foo, Chi Chung;Law, Wai Lun
随着手术机器人系统的日益普及，年轻一代的结直肠外科医生可能会提前学习机器人辅助的直肠手术。目前评估直肠外科新手学习曲线的研究非常有限。本研究旨在评估一位经验有限的外科医生在开放和腹腔镜直肠手术中的学习曲线。2013年3月至2014年10月，连续39例机器人辅助全肠系膜切除术。所有病例均由一名外科医生完成，该外科医生之前进行开放或腹腔镜低位直肠癌切除术的经验小于5例。采用累积和法对学习曲线进行分析。34例下前腹切除术，4例腹会阴切除术，1例Hartmann手术。平均总手术时间为397.2±184.3 min。没有皈依。主要并发症发生率为10.3%。用CUSUM方法对总运行时间进行分析，可以识别出三个阶段。他们是最初的8例，中间的17例，最后的14例。与第二阶段相比，第一阶段包括更多的近端肿瘤（86.3 +/- A 20.7 vs. 58.0 +/- A 34.9 mm, p = 0.04），总手术时间更短（243.5 +/- A 38.0 vs. 540.9 +/- A 133.4 min, p = 0.000），估计失血量更少（81.3 +/- A 25.9 vs. 168.8 +/- A 99.5 ml, p = 0.02）。三期与一期、二期相比，总运行时间更短（310.6 +/- A 164.5 vs. 44 5.7 +/- A 179.8 min, p = 0.03）。一期、二期、三期并发症发生率分别为12.5%、17.6%、0%。在本研究中，一名直肠外科新手的学习曲线为25例。这与那些已经掌握了腹腔镜或开放方法的人相当。手术机器人系统可能在缩短低位直肠切除术的学习曲线方面发挥作用。
With the increasing availability of the surgical robotic system, the young generation colorectal surgeons may learn robotic-assisted rectal surgery upfront. There are currently very limited studies evaluating the learning curve of novice rectal surgeons.This study aimed to evaluate the learning curve of a surgeon who had limited experience in open and laparoscopic rectal surgery.Thirty-nine consecutive robotic-assisted total mesorectal excisions were performed from March 2013 to October 2014. All cases were performed by a single surgeon whose prior experience in open or laparoscopic low rectal cancer resections was < 5 cases. The learning curve was analyzed using the cumulative sum method.Thirty-four low anterior resections, four abdomino-perineal resections, and one Hartmann's operation were performed. The mean total operating time was 397.2 +/- A 184.3 min. There was no conversion. The major complication rate was 10.3 %. When total operating time was analyzed with the CUSUM method, three phases could be identified. They are the initial eight cases, middle 17 cases, and the final 14 cases. The first phase consisted of more proximal tumors (86.3 +/- A 20.7 vs. 58.0 +/- A 34.9 mm from anal verge, p = 0.04) and was associated with a shorter total operating time (243.5 +/- A 38.0 vs. 540.9 +/- A 133.4 min, p = 0.000) and less estimated blood loss (81.3 +/- A 25.9 vs. 168.8 +/- A 99.5 ml, p = 0.02) compared to the second phase. When the third phase is compared with the first and second phase, it has shorter total operating time (310.6 +/- A 164.5 vs. 44 5.7 +/- A 179.8 min, p = 0.03). Complications rate were 12.5, 17.6, and 0 % for phase one, two, and three respectively.In this study, the learning curve for a novice rectal surgeon was 25 cases. This is comparable to those who have already mastered the technique with laparoscopic or open approach. Surgical robotic system may have a role in shortening the learning curve for low rectal resection.