Department of Pediatric Surgery, West China hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan, China.
Surg Endosc. 2021 Jun;35(6):2690-2697. doi: 10.1007/s00464-020-07695-1. Epub 2020 Jun 15.
Little data are available to assess the learning curve for robot-assisted surgery on choledochal cysts. The aim of this current study is to investigate the characteristics of the learning curve for robot-assisted choledochal cyst excisions using the da Vinci (SI) surgical system in pediatrics.
A retrospectively collected database comprising all medical records of the first 60 consecutive patients undergoing a robot-assisted choledochal cyst excision and Roux-en-Y hepaticojejunostomy using the da Vinci (SI) surgical system performed by one individual surgeon was studied. Baseline information and postoperative outcomes were collected and then learning curves were analyzed using the cumulative sum (CUSUM) method. Patients were divided into two groups including group A and group B according to the cutoff points of the learning curve. Intraoperative characteristics and short-term outcomes were compared between the two groups.
CUSUM plots revealed that the cutoff point of the learning curve was 14 cases. Comparison of the operative time between the two groups revealed that the total operative time (203.71 ± 15.27, 171.28 ± 3.62 min, P < 0.001), docking time (23.79 ± 5.81, 14.50 ± 0.98 min, P < 0.001), and console time (151.86 ± 9.77, 129.15 ± 2.96 min, P < 0.001) were decreased significantly. The intraoperative bleeding (20.36 ± 7.46 vs. 20.43 ± 9.18, P = 0.977), time to taking water (2.89 ± 0.22 vs. 3.04 ± 0.34, P = 0.115), time to starting solids diet (3.73 ± 0.17 vs. 3.79 ± 0.26, P = 0.387), hospital stay (7.51 ± 1.12 vs. 7.54 ± 0.95, P = 0.910), and the postoperative complications did not differ significantly between the two groups.
The learning curve for the robot-assisted choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children is 14 cases. This learning curve can be used as the basis for performance guidance during training in future.
目前评估机器人辅助胆管囊肿手术学习曲线的相关数据较少。本研究旨在通过达芬奇（SI）手术系统探讨小儿机器人辅助胆管囊肿切除术的学习曲线特征。
本研究回顾性收集了一名外科医生完成的 60 例连续接受机器人辅助胆管囊肿切除和 Roux-en-Y 肝肠吻合术的患者的所有病历资料，采用达芬奇（SI）手术系统。收集基线信息和术后结果，采用累积和（CUSUM）法分析学习曲线。根据学习曲线的截点，将患者分为 A 组和 B 组。比较两组的术中特点和短期结果。
CUSUM 图显示学习曲线的截点为 14 例。两组手术时间比较显示，总手术时间（203.71±15.27、171.28±3.62min，P<0.001）、对接时间（23.79±5.81、14.50±0.98min，P<0.001）和控制台时间（151.86±9.77、129.15±2.96min，P<0.001）均显著缩短。术中出血量（20.36±7.46 与 20.43±9.18，P=0.977）、饮水时间（2.89±0.22 与 3.04±0.34，P=0.115）、开始固体饮食时间（3.73±0.17 与 3.79±0.26，P=0.387）、住院时间（7.51±1.12 与 7.54±0.95，P=0.910）和术后并发症无显著差异。
小儿机器人辅助胆管囊肿切除和 Roux-en-Y 肝肠吻合术的学习曲线为 14 例。该学习曲线可作为未来培训中绩效指导的依据。
