Yao Hongliang, Li Tiegang, Chen Weidong, Lei Sanlin, Liu Kuijie, Jin Xiaoxin, Zhou Jiangjiao
Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
Front Oncol. 2020 Sep 11;10:1355. doi: 10.3389/fonc.2020.01355. eCollection 2020.
To analyze the learning curve (LC) for robotic natural orifice specimen extraction surgery (NOSES) for colorectal neoplasms and evaluate safety and feasibility during the initial LC. Patients who consecutively underwent robotic NOSES performed by two surgeons between March 2016 and October 2019 were analyzed retrospectively. The operation time was evaluated using the cumulative sum method to analyze the LC. The clinicopathological data before and after the completion of LC were extracted and compared to evaluate safety and feasibility. In total, 99 and 66 cases were scheduled for robotic NOSES by Prof. Yao and Prof. Li, respectively. The peak points of LC were observed at the 42nd and 15th cases of Yao and Li, respectively, then operation time began to decrease. Only the operation time for Yao before the completion of LC (213.3 ± 67.0 min) was longer than that after the completion of LC (143.8 ± 33.3 min). For Yao nor for Li, other indices, such as postoperative hospital stay, intraoperative blood loss, conversion to laparotomy, incidence of anastomotic leakage, reoperation rate, and 90-day mortality rate lacked significant statistical differences( > 0.05). In terms of feasibility, the number of lymph nodes harvested, positive resection margin rate, and total cost before and after the completion of LC had no significant statistical difference ( > 0.05). The cases before the completion of LC for robotic NOSES in colorectal neoplasms varied from 15 cases to 42 cases. Robotic NOSES is safe and feasible during the initial LC.
分析结直肠肿瘤机器人经自然腔道标本取出手术（NOSES）的学习曲线（LC），并评估初始LC阶段的安全性和可行性。回顾性分析2016年3月至2019年10月间由两位外科医生连续进行机器人NOSES手术的患者。使用累积和法评估手术时间以分析LC。提取并比较LC完成前后的临床病理数据，以评估安全性和可行性。姚教授和李教授分别计划进行99例和66例机器人NOSES手术。LC的峰值点分别在姚教授的第42例和李教授的第15例观察到，然后手术时间开始下降。仅姚教授在LC完成前的手术时间（213.3±67.0分钟）长于LC完成后的手术时间（143.8±33.3分钟）。对于姚教授和李教授，术后住院时间、术中失血量、中转开腹率、吻合口漏发生率、再次手术率和90天死亡率等其他指标均无显著统计学差异（>0.05）。在可行性方面，LC完成前后的淋巴结清扫数量、切缘阳性率和总成本均无显著统计学差异（>0.05）。结直肠肿瘤机器人NOSES在初始LC阶段的病例数从15例到42例不等。机器人NOSES在初始LC阶段是安全可行的。
