Torng Pao-Ling, Pan Song-Po, Hwang Jing-Shiang, Shih Ho-Jun, Chen Chi-Ling
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2017 Dec;56(6):781-787. doi: 10.1016/j.tjog.2017.10.014.
To evaluate the concurrent interaction of laparoscopic and robotic-assisted surgery in the initial learning period of endometrial cancer staging.
A retrospective cohort study was performed for the first 44 consecutive patients with endometrial cancer underwent laparoscopic (LSS) or robotic-assisted staging surgery (RSS) from February 2012 to October 2015 by a single surgeon in a tertiary care referral hospital. Demographics, diagnosis, perioperative variables, and complications were recorded. Quality of surgery was determined by the number of lymph nodes dissected and learning curve was estimated by operative time with respect to chronologic order of operation.
Twenty-four patients received LSS and 20 patients received RSS. RSS required longer operative time, but obtained more total number of lymph nodes compared with LSS (286.9 vs. 201.9 min (p < 0.001); 26.2 vs. 20.7 (p < 0.05), respectively. There were no difference in blood loss, number of para-aortic nodes removed, complications and hospital stay between the two types of surgery. An additive model based on tumor grade, body mass index, estimated blood loss and chronological order of operation was constructed to fit operative time of these two types of surgery. Proficiency of achievement was not observed for LSS and was 6 for RSS.
Operative time was longer but Lymph node dissection was easier in RSS. Learning curve for LSS to maintain similar surgical quality as RSS was not observed. The concurrent use of robotic platform in the initial practice of minimally invasive staging surgery could optimize surgical technique for LSS.
评估在子宫内膜癌分期手术的初始学习阶段，腹腔镜手术与机器人辅助手术的协同作用。
对2012年2月至2015年10月期间在一家三级转诊医院由同一位外科医生连续进行腹腔镜（LSS）或机器人辅助分期手术（RSS）的44例子宫内膜癌患者进行回顾性队列研究。记录患者的人口统计学资料、诊断结果、围手术期变量及并发症。通过清扫的淋巴结数量确定手术质量，并根据手术时间相对于手术时间顺序估计学习曲线。
24例患者接受LSS，20例患者接受RSS。与LSS相比，RSS手术时间更长，但清扫的淋巴结总数更多（分别为286.9分钟对201.9分钟（p<0.001）；26.2个对20.7个（p<0.05））。两种手术在失血量、切除的腹主动脉旁淋巴结数量、并发症及住院时间方面无差异。构建了一个基于肿瘤分级、体重指数、估计失血量和手术时间顺序的加法模型来拟合这两种手术的手术时间。LSS未观察到达到熟练程度的情况，RSS为6例。
RSS手术时间较长，但淋巴结清扫更容易。未观察到LSS能维持与RSS相似手术质量的学习曲线。在微创分期手术的初始实践中同时使用机器人平台可优化LSS的手术技术。
