Division of Upper GI Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Surg Endosc. 2012 Jan;26(1):60-7. doi: 10.1007/s00464-011-1828-5. Epub 2011 Jul 26.
Robotic surgery for gastric cancer patients has been increasing because of its many advantages over conventional laparoscopic surgery. Despite the suggestion that robotic surgery may lessen the learning curve for complex laparoscopic procedures, little is known about the learning curve for robotic gastrectomy. This study aimed to assess the learning curve of robotic gastrectomy for patients with cancer by analyzing the operation time.
The first 20 consecutive cases of robot-assisted distal gastrectomy with lymphadenectomy for gastric cancer performed by three experienced laparoscopic surgeons' using the da Vinci system were collected and reviewed. A nonlinear least-squares method was developed and used to analyze the learning curves.
Overall, the mean operation time was 247.3 ± 45.7 min, depending on each surgeon's laparoscopic experience and the patient's characteristics. After control was used for confounding factors, the stabilized operation time decreased to 211.8 min. The operation time stabilized at 8.2 cases and was reduced 111.4 min from the first case. A stable operation time was reached in 9.6 cases by surgeon A, in 18.1 cases by surgeon B, and in 6 cases by surgeon C. The stable operation time was 149.2 min for surgeon A, 127.1 min for surgeon B, and 236.8 min for surgeon C, and the reduction in operation time from the first case to stabilization was 233 min for surgeon A, 76.7 min for surgeon B, and 154.6 min for surgeon C.
Surgeons with sufficient experience in laparoscopic gastrectomy can rapidly overcome the learning curve for robotic gastrectomy. In addition, the surgeon's experience with laparoscopic gastrectomy affects the operation time after stabilization and the reduction in operation time.
由于机器人手术相对于传统腹腔镜手术具有许多优势，因此接受胃癌手术的患者越来越多地选择机器人手术。尽管有研究表明机器人手术可能会减少复杂腹腔镜手术的学习曲线，但对于机器人胃癌手术的学习曲线却知之甚少。本研究旨在通过分析手术时间来评估接受癌症治疗的患者进行机器人胃切除术的学习曲线。
我们收集了三位经验丰富的腹腔镜外科医生使用达芬奇系统进行的 20 例连续机器人辅助远端胃癌根治术和淋巴结清扫术的病例，并进行了回顾性分析。采用非线性最小二乘法分析学习曲线。
总体而言，每位外科医生的腹腔镜经验和患者特征不同，手术时间的平均值为 247.3±45.7 分钟。在控制混杂因素后，稳定的手术时间减少至 211.8 分钟。手术时间在 8.2 例时稳定，从第一例减少了 111.4 分钟。A 医生的稳定手术时间为 9.6 例，B 医生为 18.1 例，C 医生为 6 例。A 医生的稳定手术时间为 149.2 分钟，B 医生为 127.1 分钟，C 医生为 236.8 分钟，从第一例到稳定的手术时间减少分别为 233 分钟、76.7 分钟和 154.6 分钟。
有足够腹腔镜胃切除术经验的外科医生可以迅速克服机器人胃切除术的学习曲线。此外，外科医生的腹腔镜胃切除术经验会影响稳定后的手术时间和手术时间的减少。
