Learning Curve for Robot-Assisted Minimally Invasive Thoracoscopic Esophagectomy: Results From 312 Cases
Learning Curve for Robot-Assisted Minimally Invasive Thoracoscopic Esophagectomy: Results From 312 Cases
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DOI：
10.1016/j.athoracsur.2018.01.038
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发表时间：
2018-07-01
影响因子：
4.6
通讯作者：
van Hillegersberg, Richard
中科院分区：
文献类型：
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作者：
van der Sluis, Pieter C.;Ruurda, Jelle P.;van Hillegersberg, Richard
背景资料。胸段腹腔镜机器人辅助微创食道切除术(Ramie)于2003年问世。苎麻被证明是安全的，并且在肿瘤上有效。这项研究的目的是评估一个新引进的外科医生(外科医生2)的学习曲线和指导程序。“学习曲线”被定义为外科医生必须进行的手术次数，以达到稳定的表现水平。描述Proctor和新引入的外科医生2的学习曲线的熟练程度的衡量标准包括手术时间、失血量和转换率，并使用累积和方法进行分析。将新引进的外科医生与同期的普外科医生的结果进行比较。检察官完成了312个手术中的232个(74%)，外科医生2完成了312个手术中的80个(26%)。检察官在55个月内进行了70次手术后，达到了熟练程度。针对外科医生2的结构化督导计划开始于作为餐桌外科医生的20例辅助手术，随后是5例观察病例和15例监督病例。外科医生2在手术时间、出血量、中转率、根治性和并发症方面与检察官的水平相同。外科医生2在13个月内完成24例(15例督导，9例独立病例)的胸腹腔镜术，手术次数减少66%，手术时间缩短76%。胸腔腹腔镜术的学习阶段包括55个月的70次手术。对苎麻的结构化监督大大减少了达到熟练程度所需的程序数量和时间。(C)2018年，由胸外科医生学会主办
Background. Thoracic laparoscopic robot-assisted minimally invasive esophagectomy (RAMIE) was developed in 2003. RAMIE was shown to be safe and oncologically effective. The aim of this study was to assess the learning curve and the proctoring program for a newly introduced surgeon (surgeon 2).Methods. The "learning curve" was defined as the number of operations that must be performed by a surgeon to achieve a steady level of performance. Measures of proficiency to describe the learning curve of the proctor and the newly introduced surgeon 2 included operating time, blood loss, and conversion rates and were analyzed using the cumulative sum method. Results of the newly introduced surgeon were compared with the proctor in the same period of time.Results. The proctor performed 232 of 312 procedures (74%) and surgeon 2 performed 80 of 312 procedures (26%). The proctor reached proficiency after 70 procedures in 55 months. The structured proctoring program for surgeon 2 started with 20 procedures as assisting table surgeon, followed by 5 observational and 15 supervised cases. Surgeon 2 performed at the same level as the proctor concerning operating time, blood loss, conversion rates, radicality, and complications. For surgeon 2, the learning phase of thoracic laparoscopic RAMIE was completed within 24 cases (15 supervised and 9 independent cases) in 13 months; a reduction of 66% in the number of operations and a reduction of 76% in time, compared with the proctor.Conclusions. The learning phase of thoracic laparoscopic RAMIE consisted of 70 procedures in 55 months. A structured proctoring for RAMIE substantially reduced the number of procedures and time required to achieve proficiency. (C) 2018 by The Society of Thoracic Surgeons