Department of Thoracic Surgery, West China Hospital, Sichuan University, Sichuan, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Sichuan, China.
Ann Thorac Surg. 2018 Apr;105(4):1024-1030. doi: 10.1016/j.athoracsur.2017.11.058. Epub 2017 Dec 27.
Robot-assisted McKeown esophagectomy is a promising but technically demanding procedure; thus, a learning curve should be defined to guide training and allow implementation of this technique.
This study retrospectively reviewed the prospectively collected data of 72 consecutive patients undergoing robot-assisted McKeown esophagectomy by a single surgical team experienced in open and thoracolaparoscopic esophagectomy. The cumulative sum method was used to analyze the learning curve. Patients were divided into two groups in chronological order, defining the surgeon's early (group 1: the first 26 patients) and late experience (group 2: the next 46 patients). Demographic data, intraoperative characteristics, and short-term surgical outcomes were compared between the two groups.
Cumulative sum plots revealed decreasing thoracic and abdominal docking time, thoracic and abdominal console time, and total surgical time after patient 9, 16, 26, 14, and 26, respectively. The mean number of lymph nodes resected was greater in group 2 than in group 1 (22.6 ± 8.2 vs 17.4 ± 6.7, p = 0.008). No other clinic or pathologic characteristics were observed as significantly different.
For a surgeon experienced in open and thoracolaparoscopic esophagectomy, experience of 26 cases is required to gain early proficiency of robot-assisted McKeown esophagectomy. A learning curve for robot-assisted esophagus dissection would require operations on 26 patients and stomach mobilization would require operations on 14 patients. For the tableside assistant, experience of at least nine cases is needed to achieve an optimal technical level for thoracic docking and 16 cases for abdominal docking.
机器人辅助 McKeown 食管切除术是一种有前途但技术要求很高的手术；因此，应该定义一个学习曲线来指导培训并允许实施这项技术。
本研究回顾性分析了由一个在开放和胸腹腔镜食管切除术方面经验丰富的外科团队连续对 72 例患者进行机器人辅助 McKeown 食管切除术的前瞻性收集数据。使用累积和方法分析学习曲线。患者按时间顺序分为两组，定义外科医生的早期（第 1 组：前 26 例患者）和晚期经验（第 2 组：接下来的 46 例患者）。比较两组患者的一般资料、术中特征和短期手术结果。
累积和图显示，第 9、16、26、14 和 26 例患者后，胸腔和腹腔对接时间、胸腔和腹腔控制台时间以及总手术时间分别呈下降趋势。第 2 组切除的淋巴结平均数大于第 1 组（22.6±8.2 vs. 17.4±6.7，p=0.008）。没有观察到其他临床或病理特征有显著差异。
对于具有开放和胸腹腔镜食管切除术经验的外科医生，需要进行 26 例手术才能获得机器人辅助 McKeown 食管切除术的早期熟练程度。机器人辅助食管游离术的学习曲线需要对 26 例患者进行手术，胃游离术需要对 14 例患者进行手术。对于手术助手来说，需要至少进行 9 例手术才能达到胸腔对接的最佳技术水平，进行 16 例手术才能达到腹腔对接的最佳技术水平。
