Kim Im-kyung, Kang Jeonghyun, Park Yoon Ah, Kim Nam Kyu, Sohn Seung-Kook, Lee Kang Young
Department of Surgery, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
Int J Colorectal Dis. 2014 Jun;29(6):693-9. doi: 10.1007/s00384-014-1858-2. Epub 2014 Apr 27.
The objective of this study is to ascertain the impact of laparoscopic colorectal surgery (LCS) experience on the learning curve of robotic rectal cancer surgery (RRS). Whether LCS experience is mandatory on overcoming the learning curve of RRS or not remains undetermined.
Before starting the robotic procedure, surgeon A had a limited experience of less than 30 LCS cases, whereas surgeon B had performed more than 300 cases of LCS. From the beginning, 100 consecutive, unselected RRS cases performed by each of the two surgeons were retrospectively analyzed (groups A and B). Perioperative surgical and oncologic outcomes were compared between the two groups.
Clinicopathological characteristics between the two groups were similar. One case in group A was converted to open surgery. Mean operation time was shorter in group A than that of group B (272 vs. 344 min, p < 0.001). Overall perioperative morbidity rates were not different between the two groups (17.0 vs. 10.0 %, p = 0.214). There was no difference of circumferential resection margin positivity rate and retrieved lymph node numbers. In group A, the operation time decreased with a steep slope until 17 cases on the moving average curve. The slope in group B maintained a steady state and showed no remarkable changes throughout the study period.
A one-step transition from open to robotic rectal cancer surgery can be achieved without having extensive prior laparoscopic experience.
本研究的目的是确定腹腔镜结直肠手术（LCS）经验对机器人直肠癌手术（RRS）学习曲线的影响。LCS经验对于克服RRS学习曲线是否必不可少仍未确定。
在开始机器人手术之前，外科医生A的LCS经验有限，不足30例，而外科医生B已进行了300多例LCS。从一开始，对两位外科医生各自连续进行的100例未经筛选的RRS病例进行回顾性分析（A组和B组）。比较两组的围手术期手术和肿瘤学结果。
两组之间的临床病理特征相似。A组有1例转为开放手术。A组的平均手术时间短于B组（272对344分钟，p <0.001）。两组的总体围手术期发病率无差异（17.0对10.0％，p = 0.214）。环周切缘阳性率和回收淋巴结数量无差异。在A组中，移动平均曲线上直到第17例手术时间呈陡坡下降。B组的斜率保持稳定状态，在整个研究期间没有明显变化。
无需丰富的腹腔镜手术经验，即可实现从开放手术到机器人直肠癌手术的一步过渡。
