Binet Aurélien, Fourcade Laurent, Amar Sarah, Alzahrani Khalid, Cook Ann-Rose, Braïk Karim, Cros Jérôme, Longis Bernard, Villemagne Thierry, Lardy Hubert, Ballouhey Quentin
Pediatric Surgery Unit, Centre Hospitalier Regional Universitaire de Tours, Tours, France.
Pediatric Surgery Unit, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France.
Eur J Pediatr Surg. 2019 Apr;29(2):173-178. doi: 10.1055/s-0037-1615279. Epub 2017 Dec 19.
Laparoscopic fundoplicature for gastroesophageal reflux disease has become the gold standard because of the improvement of postoperative rehabilitation compared with the open procedure. The robot-assisted surgery has brought new advantages for the patient and the surgeon compared with laparoscopy. We studied this new approach and the learning curve.
Sixty robot-assisted fundoplicatures were performed in two university pediatric surgery centers. Data of the patients were recorded, including peroperative data (operation length and complications), postoperative recoveries, and clinical evolution. The learning curve was evaluated retrospectively and each variable was compared along this learning curve.
We observed a flattening of the learning curve after the 20th case for one surgeon. The mean operative time decreased significantly to 80 ± 10 minutes after 20 cases. There were no conversions to an open procedure. A revision surgery was indicated for 4.7% of the patients by a surgical robot-assisted laparoscopic approach.
The robotic system appears to add many advantages for surgical ergonomic procedures. There is a potential benefit in operating time with a short technical apprenticeship period. The setting up system is easy with a short docking time.
由于与开放手术相比，腹腔镜胃底折叠术术后康复情况有所改善，已成为治疗胃食管反流病的金标准。与腹腔镜手术相比，机器人辅助手术为患者和外科医生带来了新的优势。我们研究了这种新方法及其学习曲线。
在两个大学儿科手术中心进行了60例机器人辅助胃底折叠术。记录患者的数据，包括手术中的数据（手术时长和并发症）、术后恢复情况以及临床进展。对学习曲线进行回顾性评估，并沿着这条学习曲线比较每个变量。
我们观察到，对于一位外科医生而言，在第20例手术后学习曲线趋于平缓。20例手术后，平均手术时间显著降至80±10分钟。没有转为开放手术的情况。通过机器人辅助腹腔镜手术方法，4.7%的患者需要进行翻修手术。
机器人系统似乎为手术的人体工程学操作增添了许多优势。在较短的技术学徒期内，手术时间可能会受益。设置系统简便，对接时间短。
