Byrn John C, Hrabe Jennifer E, Charlton Mary E
Division of Gastrointestinal, Minimally Invasive, and Bariatric Surgery, Departments of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive 4577 JCP, Iowa City, IA, 52242, USA,
Surg Endosc. 2014 Nov;28(11):3101-7. doi: 10.1007/s00464-014-3591-x. Epub 2014 Jun 14.
Data are limited about the robotic platform in rectal dissections, and its use may be perceived as prohibitively expensive or difficult to learn. We report our experience with the initial robotic-assisted rectal dissections performed by a single surgeon, assessing learning curve and cost.
Following IRB approval, a retrospective chart review was conducted of the first 85 robotic-assisted rectal dissections performed by a single surgeon between 9/1/2010 and 12/31/2012. Patient demographic, clinicopathologic, procedure, and outcome data were gathered. Cost data were obtained from the University HealthSystem Consortium (UHC) database. The first 43 cases (Time 1) were compared to the next 42 cases (Time 2) using multivariate linear and logistic regression models.
Indications for surgery were cancer for 51 patients (60 %), inflammatory bowel disease for 18 (21 %), and rectal prolapse for 16 (19 %). The most common procedures were low anterior resection (n = 25, 29 %) and abdominoperineal resection (n = 21, 25 %). The patient body mass index (BMI) was statistically different between the two patient groups (Time 1, 26.1 kg/m(2) vs. Time 2, 29.4 kg/m(2), p = 0.02). Complication and conversion rates did not differ between the groups. Mean operating time was significantly shorter for Time 2 (267 min vs. 224 min, p = 0.049) and remained significant in multivariate analysis. Though not reaching statistical significance, the mean observed direct hospital cost decreased ($17,349 for Time 1 vs. $13,680 for Time 2, p = 0.2). The observed/expected cost ratio significantly decreased (1.47 for Time 1 vs. 1.05 for Time 2, p = 0.007) but did not remain statistically significant in multivariate analyses.
Over the series, we demonstrated a significant improvement in operating times. Though not statistically significant, direct hospital costs trended down over time. Studies of larger patient groups are needed to confirm these findings and to correlate them with procedure volume to better define the learning curve process.
关于机器人平台在直肠手术中的应用数据有限，其使用可能被认为成本过高或难以掌握。我们报告了一位外科医生首次进行机器人辅助直肠手术的经验，评估学习曲线和成本。
经机构审查委员会（IRB）批准，对一位外科医生在2010年9月1日至2012年12月31日期间进行的前85例机器人辅助直肠手术进行回顾性病历审查。收集患者的人口统计学、临床病理、手术及结局数据。成本数据来自大学卫生系统联合会（UHC）数据库。使用多变量线性和逻辑回归模型将前43例病例（时间1）与接下来的42例病例（时间2）进行比较。
手术指征为癌症的患者有51例（60%），炎症性肠病的有18例（21%），直肠脱垂的有16例（19%）。最常见的手术是低位前切除术（n = 25，29%）和腹会阴联合切除术（n = 21，25%）。两组患者的体重指数（BMI）在统计学上存在差异（时间1，26.1kg/m² 对时间2，29.4kg/m²，p = 0.02）。两组的并发症和中转率无差异。时间2的平均手术时间显著缩短（267分钟对224分钟，p = 0.049），在多变量分析中仍具有显著性。虽然未达到统计学意义，但观察到的直接医院成本有所下降（时间1为17349美元，时间2为13680美元，p = 0.2）。观察到的成本与预期成本之比显著下降（时间1为1.47，时间2为1.05，p = 0.007），但在多变量分析中未保持统计学意义。
在这一系列手术中，我们证明了手术时间有显著改善。虽然无统计学意义，但直接医院成本随时间呈下降趋势。需要对更大的患者群体进行研究以证实这些发现，并将其与手术例数相关联，以更好地界定学习曲线过程。
