Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Thorac Cancer. 2021 May;12(9):1431-1440. doi: 10.1111/1759-7714.13927. Epub 2021 Mar 11.
We aim to assess the learning curve of robotic portal lobectomy with four arms (RPL-4) in patients with pulmonary neoplasms using prospectively collected data.
Data from 100 consecutive cases with lung neoplasms undergoing RPL-4 were prospectively accumulated into a database between June 2018 and August 2019. The Da Vinci Si system was used to perform RPL-4. Regression curves of cumulative sum analysis (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) were fit to identify different phases of the learning curve. Clinical indicators and patient characteristics were compared between different phases.
The mean operative time, console time, and docking time for the entire cohort were 130.6 ± 53.8, 95.5 ± 52.3, and 6.4 ± 3.0 min, respectively. Based on CUSUM analysis of console time, the surgical experience can be divided into three different phases: 1-10 cases (learning phase), 11-51 cases (plateau phase), and >51 cases (mastery phase). RA-CUSUM analysis revealed that experience based on 56 cases was required to truly master this technique. Total operative time (p < 0.001), console time (p < 0.001), and docking time (p = 0.026) were reduced as experience increased. However, other indicators were not significantly different among these three phases.
The RPL-4 learning curve can be divided into three phases. Ten cases were required to pass the learning curve, but the mastery of RPL-4 for satisfactory surgical outcomes requires experience with at least 56 cases.
本研究旨在通过前瞻性收集的数据，评估使用四臂机器人肺段切除术（RPL-4）治疗肺部肿瘤患者的学习曲线。
2018 年 6 月至 2019 年 8 月，前瞻性地收集了 100 例连续接受 RPL-4 治疗的肺部肿瘤患者的数据，并将其纳入数据库。使用达芬奇 Si 系统进行 RPL-4。使用累积和分析（CUSUM）和风险调整累积和分析（RA-CUSUM）回归曲线来识别学习曲线的不同阶段。比较不同阶段的临床指标和患者特征。
整个队列的平均手术时间、控制台时间和对接时间分别为 130.6±53.8、95.5±52.3 和 6.4±3.0 分钟。根据控制台时间的 CUSUM 分析，手术经验可分为三个不同阶段：1-10 例（学习阶段）、11-51 例（平台阶段）和>51 例（掌握阶段）。RA-CUSUM 分析表明，需要 56 例经验才能真正掌握这项技术。随着经验的增加，总手术时间（p<0.001）、控制台时间（p<0.001）和对接时间（p=0.026）均降低。然而，在这三个阶段，其他指标没有显著差异。
RPL-4 的学习曲线可分为三个阶段。完成 10 例手术即可通过学习曲线，但要达到满意的手术效果，需要至少 56 例的经验才能掌握 RPL-4。
