Ricci Claudio, Casadei Riccardo, Buscemi Salvatore, Taffurelli Giovanni, D'Ambra Marielda, Pacilio Carlo Alberto, Minni Francesco
Dipartimento di Scienze Mediche e Chirurgiche, Chirurgia Generale-Minni (DIMEC), Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy,
Surg Today. 2015 Jan;45(1):50-6. doi: 10.1007/s00595-014-0872-x. Epub 2014 Mar 9.
The factors related to the learning curve for laparoscopic distal pancreatectomy have rarely been evaluated.
A retrospective study of 32 patients who underwent a laparoscopic distal pancreatectomy performed at a high-volume center by a single pancreatic surgeon experienced with laparoscopic surgery was conducted. Pre-, intra- and postoperative data were collected. The primary endpoint was the length of the operation. The secondary endpoints were the conversion and reoperation rates, overall postoperative morbidity and mortality rates, the length of hospital stay and rate of unplanned splenectomy.
The length of the operation and the cumulative sum of the procedures presented a logarithmic correlation (P = 0.048). The learning curve appeared to have been completed after 17 procedures (P = 0.040). The multivariate analysis confirmed that the completion of the learning curve (CLC) reduced the length of the operation by 18 % (P = 0.009), but extended resection increased the length of the operation (P = 0.023). The conversion and reoperation rates, overall postoperative morbidity and mortality rates and length of the hospital stay were not related to the CLC. Unplanned splenectomy was more frequently performed during the first 17 procedures.
The length of the operation seems to be the main factor related to the CLC for laparoscopic distal pancreatectomy. The learning curve could be considered to be completed after about 17 procedures if performed by surgeons experienced with laparoscopic techniques at high-volume centers.
与腹腔镜胰体尾切除术学习曲线相关的因素鲜有评估。
对32例行腹腔镜胰体尾切除术的患者进行回顾性研究，手术由一位在高容量中心经验丰富的腹腔镜手术胰腺外科医生完成。收集术前、术中和术后数据。主要终点是手术时长。次要终点包括中转开腹率、再次手术率、术后总体发病率和死亡率、住院时长及意外脾切除术发生率。
手术时长与手术累积例数呈对数相关（P = 0.048）。17例手术后学习曲线似乎完成（P = 0.040）。多因素分析证实，学习曲线完成（CLC）使手术时长缩短18%（P = 0.009），但扩大切除会增加手术时长（P = 0.023）。中转开腹率、再次手术率、术后总体发病率和死亡率以及住院时长与CLC无关。在前17例手术中意外脾切除术更常发生。
手术时长似乎是腹腔镜胰体尾切除术CLC的主要相关因素。如果由高容量中心有腹腔镜技术经验的外科医生实施，约17例手术后可认为学习曲线完成。
