Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Thorac Surg. 2019 May;107(5):1515-1522. doi: 10.1016/j.athoracsur.2018.11.041. Epub 2018 Dec 19.
Robotic segmentectomy has been suggested as a safe and effective management for early lung cancer and benign lung diseases. However, no large case series have documented the learning curve for this technically demanding procedure.
We conducted a retrospective study for robotic segmentectomy performed by the same surgeon between June 2015 and November 2017. The learning curve was initially analyzed using the cumulative sum (CUSUM) method to assess changes in the total operative times across the case sequence. Subsequently, an in-depth learning curve was generated using the risk-adjusted CUMSUM method, which considered perioperative risk factors and surgical failure.
This study included 104 cases, and 87 were malignant. The median operative time was 145 minutes (interquartile range [IQR], 120 to 180) and the median blood loss was 100 mL (IQR, 50 to 100). The median length of stay was 4 days (IQR, 3 to 5). Based on the CUSUM and risk-adjusted CUSUM analyses, the learning curve could be divided into 3 different phases: phase I, the initial learning period (first to 21st operation); phase II, the consolidation period (22nd to 46th operation); and phase III, the experienced period (47th to 104th operation). The operative time and intraoperative blood loss tended to decrease after the initial learning phase. Other perioperative outcomes were not significantly different among the 3 phases.
The learning curve of robotic segmentectomy consisted of 3 phases. The technical competency for assuring feasible perioperative outcomes was achieved in phase II at the 40th operation.
机器人肺段切除术已被建议用于早期肺癌和良性肺部疾病的安全有效的治疗方法。然而，尚无大样本病例系列记录这一技术要求较高的手术的学习曲线。
我们对同一位外科医生于 2015 年 6 月至 2017 年 11 月期间进行的机器人肺段切除术进行了回顾性研究。最初使用累积和（CUSUM）方法分析学习曲线，以评估手术序列中总手术时间的变化。随后，使用风险调整的 CUMSUM 方法生成深入的学习曲线，该方法考虑了围手术期危险因素和手术失败。
本研究共纳入 104 例患者，其中 87 例为恶性肿瘤。中位手术时间为 145 分钟（四分位距 [IQR]，120 至 180），中位出血量为 100ml（IQR，50 至 100），中位住院时间为 4 天（IQR，3 至 5）。根据 CUSUM 和风险调整的 CUMSUM 分析，学习曲线可分为 3 个不同阶段：第 I 阶段，初始学习阶段（第 1 至 21 次手术）；第 II 阶段，巩固阶段（第 22 至 46 次手术）；第 III 阶段，熟练阶段（第 47 至 104 次手术）。在初始学习阶段之后，手术时间和术中出血量趋于减少。在 3 个阶段中，其他围手术期结局没有显著差异。
机器人肺段切除术的学习曲线由 3 个阶段组成。在第 40 次手术时，达到了第 II 阶段保证可行的围手术期结局的技术能力。
