Learning curve for robot-assisted Roux-en-Y gastric bypass
Learning curve for robot-assisted Roux-en-Y gastric bypass
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DOI：
10.1007/s00464-011-2008-3
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发表时间：
2012-04-01
影响因子：
3.1
通讯作者：
Morel, Philippe
中科院分区：
文献类型：
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作者：
Buchs, Nicolas C.;Pugin, Francois;Morel, Philippe
背景机器人辅助Roux-en-Y胃旁路术（RYGBP）正在迅速发展成为减肥领域的一种重要手术方法。然而，与这种新方法相关的特定学习曲线仍然没有得到充分的研究。本研究旨在评估机器人辅助RYGBP的学习曲线。方法2008年12月至2010年12月期间，由一名外科医生在先进的腹腔镜手术中已经有经验，但不是在减肥手术中进行了一系列的64个连续的机器人辅助RYGBP程序。所有数据均前瞻性地收集在数据库中，并进行回顾性审查。学习曲线采用累积和法（Cumulative Sum，简称CUM）进行评价。这些患者的平均年龄为43岁，平均体重指数（BMI）为44.5 kg/m2。平均手术时间（OT）为238.1 min（范围，150-400 min）。共发生6例并发症（9.4%）。学习曲线由两个不同的阶段组成：第1阶段（最初的14例;平均OT，288.9分钟）和第2阶段（随后的病例;平均OT，223.6分钟），这代表了掌握阶段，OT减少（P = 0.0001）。两组在性别、年龄和BMI方面相似。这两个阶段没有不同的并发症或住院stay.Conclusions这一系列证实了以前的研究结果的可行性和安全性的机器人RYGBP，即使在有限的经验与腹腔镜RYGBP。本文中报告的数据表明，机器人辅助RYGBP的学习阶段可以用14例实现。
Background Robot-assisted Roux-en-Y gastric bypass (RYGBP) is rapidly evolving as an important surgical approach in the bariatric field. However, the specific learning curve associated with this new approach remains poorly investigated. This study aimed to evaluate the learning curve for robot-assisted RYGBP.Methods A series of 64 consecutive robot-assisted RYGBP procedures were performed between December 2008 and December 2010 by a single surgeon already experienced in advanced laparoscopic procedures but not in bariatric surgery. All data were collected prospectively in a database and reviewed retrospectively. The learning curve was evaluated using the cumulative sum (CUSUM) method.Results Women comprised 76.6% and men 23.4% of this series. These patients had a mean age of 43 years and a mean body mass index (BMI) of 44.5 kg/m(2). The mean operative time (OT) was 238.1 min (range, 150-400 min). A total of six complications occurred (9.4%). The CUSUM learning curve consisted of two distinct phases: phase 1 (the initial 14 cases; mean OT, 288.9 min) and phase 2 (the subsequent cases; mean OT, 223.6 min), which represented the mastery phase, with a decrease in OT (P = 0.0001). The two groups were similar in terms of gender, age, and BMI. The two phases did not differ in terms of complications or hospital stay.Conclusions This series confirms previous study findings concerning the feasibility and the safety of robotic RYGBP even after a limited experience with laparoscopic RYGBP. The data reported in this article suggest that the learning phase for robot-assisted RYGBP can be achieved with 14 cases.