Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Surg Educ. 2018 Nov;75(6):1598-1605. doi: 10.1016/j.jsurg.2018.04.018. Epub 2018 Jun 19.
This study aimed to assess the learning curve of robotic rectal surgery, a procedure that has gained increasing focus in recent years because it is expected that the advanced devices used in this approach provide advantages resulting in a shorter learning curve than that of laparoscopic surgery. However, no studies have assessed the learning curve of robotic rectal surgery, especially when lateral lymph node dissection is required.
This was a nonrandomized, retrospective study from a single institution.
All consecutive patients who underwent robotic rectal or sigmoid colon surgery by a single surgeon between February 2012 and July 2016 in the University of Tokyo Hospital were enrolled. The learning curve for console time was assessed using a cumulative sum analysis and multiple linear regression analysis.
A total of 131 consecutive patients underwent robotic rectal or sigmoid colon surgery performed by a single experienced surgeon. Of these, 41 patients received lateral lymph node dissection.
A cumulative sum plot for console time demonstrated that the learning period could be divided into 3 phases: Phase I, Cases 1 to 19; Phase II, Cases 20 to 78; and Phase III, Cases 79 to 131. Multiple linear regression analysis indicated that console time decreased significantly from one phase to another (Phase I-II, Δconsole time 83.0 minutes; Phase II-III, Δconsole time 40.1 minutes). Other factors affecting console time included body mass index, operative procedure, and lateral lymph node dissection, but not neoadjuvant therapy (such as chemoradiotherapy) or depth of invasion. Lateral lymph node dissection required an additional 138.4 minutes.
Our findings suggest that the first phase of the learning curve consists of the first 19 cases, which seems sufficient to master the manipulation of robotic arms and to understand spatial relationships unique to the robotic procedure.
本研究旨在评估机器人直肠手术的学习曲线。近年来，机器人直肠手术因其使用的先进设备而备受关注，预计该手术的学习曲线比腹腔镜手术更短。然而，目前尚无研究评估机器人直肠手术的学习曲线，特别是在需要进行侧方淋巴结清扫时。
这是一项来自单中心的非随机回顾性研究。
本研究纳入了 2012 年 2 月至 2016 年 7 月期间，由同一位外科医生在东京大学医院行机器人直肠或乙状结肠手术的所有连续患者。使用累积和分析和多元线性回归分析评估控制台时间的学习曲线。
共有 131 例连续患者由一位经验丰富的外科医生行机器人直肠或乙状结肠手术，其中 41 例接受了侧方淋巴结清扫。
控制台时间的累积和图表明，学习阶段可以分为 3 个阶段：第 I 阶段，病例 1 至 19 例；第 II 阶段，病例 20 至 78 例；第 III 阶段，病例 79 至 131 例。多元线性回归分析表明，控制台时间从一个阶段到另一个阶段显著下降（第 I-II 阶段，控制台时间减少 83.0 分钟；第 II-III 阶段，控制台时间减少 40.1 分钟）。影响控制台时间的其他因素包括体重指数、手术程序和侧方淋巴结清扫，但与新辅助治疗（如放化疗）或浸润深度无关。侧方淋巴结清扫需要额外的 138.4 分钟。
我们的研究结果表明，学习曲线的第 1 阶段包括前 19 例病例，这似乎足以掌握机器人手臂的操作，并理解机器人手术特有的空间关系。
