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复杂机器人辅助与腹腔镜肝切除学习曲线的比较分析

Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection.

作者信息

Efanov Mikhail, Alikhanov Ruslan, Tsvirkun Victor, Kazakov Ivan, Melekhina Olga, Kim Pavel, Vankovich Andrey, Grendal Konstantin, Berelavichus Stanislav, Khatkov Igor

机构信息

Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia.

Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia.

出版信息

HPB (Oxford). 2017 Sep;19(9):818-824. doi: 10.1016/j.hpb.2017.05.003. Epub 2017 Jun 7.

Abstract

BACKGROUND

There is no comparative analysis of the learning curves for robot-assisted and laparoscopic liver resection. We aimed to compare learning curves in complex robotic and conventional laparoscopic liver resections with regards to estimation of the difficulty index score.

METHODS

The results of 131 consecutive liver resections were analyzed retrospectively (40 robot-assisted and 91 laparoscopic). The learning curve evaluation was based on calculation of procedures number before significant change of the difficulty index for minimally invasive liver resection or the rate of posterosuperior segments resection. Groups of early and late experience were compared in every type of approach (robot-assisted and laparoscopic).

RESULTS

Significant increase of difficulty index (from 5.0 [3.0-7.7] to 7.3 [4.3-10.2]) of robotic procedures required 16 procedures. It was necessary to perform 29 laparoscopic resections in order to significantly increase the rate of laparoscopic posterosuperior segments resection but without significant increase of difficulty index. The implementation of minimally invasive liver resection started with the robotic approach.

CONCLUSION

The learning curve for robot-assisted liver resections is shorter in comparison with laparoscopic resections. The inclusion of robot-assisted resections in a minimally invasive liver surgery program may be useful to rapidly increase the complexity of laparoscopic liver resections.

摘要

背景

目前尚无关于机器人辅助肝切除和腹腔镜肝切除学习曲线的比较分析。我们旨在比较复杂机器人肝切除和传统腹腔镜肝切除在难度指数评分估计方面的学习曲线。

方法

回顾性分析131例连续肝切除的结果(40例机器人辅助手术和91例腹腔镜手术)。学习曲线评估基于计算微创肝切除难度指数或后上段切除率发生显著变化之前的手术例数。对每种手术方式(机器人辅助和腹腔镜)的早期和晚期经验组进行比较。

结果

机器人手术难度指数显著增加(从5.0[3.0 - 7.7]增至7.3[4.3 - 10.2])需要16例手术。为显著提高腹腔镜后上段切除率但不显著增加难度指数,需要进行29例腹腔镜切除术。微创肝切除手术从机器人手术方式开始实施。

结论

与腹腔镜肝切除相比,机器人辅助肝切除的学习曲线更短。在微创肝手术项目中纳入机器人辅助肝切除可能有助于快速提高腹腔镜肝切除的复杂性。

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