Kim H-I, Park M S, Song K J, Woo Y, Hyung W J
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Statistics, Sungshin Women's University, College of Natural Science, Seoul, Republic of Korea.
Eur J Surg Oncol. 2014 Oct;40(10):1346-54. doi: 10.1016/j.ejso.2013.09.011. Epub 2013 Sep 17.
The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success.
We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality.
Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success.
The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory.
与腹腔镜手术相比，机器人胃癌切除术的学习曲线尚未得到评估。我们基于手术时间和手术成功率比较了机器人胃癌切除术和腹腔镜胃癌切除术的学习曲线。
我们分析了2003年5月至2009年4月由同一外科医生实施的172例机器人远端胃癌切除术和481例腹腔镜远端胃癌切除术。使用移动平均值和非线性回归分析对手术时间进行分析。通过累积和图评估手术成功率，目标失败率为10%。手术失败定义为转为腹腔镜或开放手术、分期时淋巴结清扫不足、切缘受累、术后发病率和死亡率。
移动平均值和非线性回归分析表明，机器人胃癌切除术分别在95例和121例时手术时间达到稳定状态，腹腔镜胃癌切除术分别在270例和262例时达到稳定状态。累积和图显示机器人胃癌切除术无手术成功的分界点，腹腔镜胃癌切除术在80例时有分界点。排除首次机器人胃癌切除术之前实施的最初148例腹腔镜胃癌切除术，两组在达到手术时间稳定状态时的病例数相似，且在手术成功分析中均无分界点。
腹腔镜手术经验可能会影响机器人胃癌切除术的学习过程。经验丰富的腹腔镜外科医生达到稳定状态所需的机器人胃癌切除病例数较少。此外，机器人胃癌切除术的手术效果令人满意。
