Napoli N, Kauffmann E F, Palmeri M, Miccoli M, Costa F, Vistoli F, Amorese G, Boggi Ugo
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Dig Surg. 2016;33(4):299-307. doi: 10.1159/000445015. Epub 2016 May 25.
BACKGROUND/PURPOSE: Few data are available on the learning curve (LC) in robot-assisted pancreaticoduodenectomy (RAPD) and no study specifically addresses the LC of a single surgeon.
The LC of a single surgeon in RAPD was determined using the cumulative sum method, based on operative time (OT). Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of index operation.
Seventy RAPD were analyzed. One operation was converted to open surgery (1.4%). One patient died within 30 days (1.4%) and one within 90 days (2.8%). Postoperative complications occurred in 53 patients (75.7%) and exceeded Clavien-Dindo grade IIIb in 7 patients (10%). OT dropped after 33 operations from a mean of 564 ± 101.7 min to a mean of 484.1 ± 77.9 min (p = 0.0005) and was associated to reduced incidence of delayed gastric emptying (72.7 vs. 48.7%; p = 0.039). The rate of hospital readmission improved after 40 operations from 20.0 (8 of 40) to 3.3% (1 of 30) (p = 0.04).
RAPD was safely feasible in selected patients. OT dropped after the first 33 operations and was associated with reduced rate of delayed gastric emptying. Readmission rate improved after 40 operations.
背景/目的：关于机器人辅助胰十二指肠切除术（RAPD）学习曲线（LC）的数据较少，且尚无研究专门探讨单一外科医生的学习曲线。
基于手术时间（OT），采用累积和法确定单一外科医生在RAPD中的学习曲线。数据从前瞻性维护的数据库中提取，并对索引手术90天内发生的所有事件进行回顾性分析。
分析了70例RAPD。1例手术转为开放手术（1.4%）。1例患者在30天内死亡（1.4%），1例在90天内死亡（2.8%）。53例患者发生术后并发症（75.7%），7例患者并发症超过Clavien-Dindo IIIb级（10%）。33例手术后OT从平均564±101.7分钟降至平均484.1±77.9分钟（p = 0.0005），并与胃排空延迟发生率降低相关（72.7%对48.7%；p = 0.039）。40例手术后再次入院率从20.0%（40例中的8例）降至3.3%（30例中的1例）（p = 0.04）。
RAPD在选定患者中安全可行。前33例手术后OT下降，并与胃排空延迟率降低相关。40例手术后再入院率改善。
