Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
Faculty of Electrical Engineering, Mathematics and Computer Science, Institute of Technical Medicine, Twente University, Enschede, The Netherlands.
Surg Endosc. 2022 Mar;36(3):2096-2104. doi: 10.1007/s00464-021-08496-w. Epub 2021 Apr 9.
The current standard treatment for external rectal prolapse and symptomatic high-grade internal rectal prolapse is surgical correction with minimally invasive ventral mesh rectopexy using either laparoscopy or robotic assistance. This study examines the number of procedures needed to complete the learning curve for robot-assisted ventral mesh rectopexy (RVMR) and reach adequate performance.
A retrospective analysis of all primary RVMR from 2011 to 2019 performed in a tertiary pelvic floor clinic by two colorectal surgeons (A and B) was performed. Both surgeons had previous experience with laparoscopic rectopexy, but no robotic experience. Skin-to-skin operating times (OT) were assessed using LC-CUSUM analyses. Intraoperative and postoperative complications were analyzed using CUSUM analyses.
A total of 182 (surgeon A) and 91 (surgeon B) RVMRs were performed in total. There were no relevant differences in patient characteristics between the two surgeons. Median OT was 75 min (range 46-155; surgeon A) and 90 min (range 63-139; surgeon B). The learning curve regarding OT was completed after 36 procedures for surgeon A and 55 procedures for surgeon B. Both before and after completion of the learning curve, intraoperative and postoperative complication rates remained below a predefined acceptable level of performance.
36 to 55 procedures are required to complete the learning curve for RVMR. The implementation of robotic surgery does not inflict any additional risks on patients at the beginning of a surgeon's learning curve.
目前，对外痔直肠脱垂和有症状的高位直肠内脱垂的标准治疗方法是采用微创经腹网片直肠固定术（RVMR）进行手术矫正，该手术可通过腹腔镜或机器人辅助完成。本研究旨在探讨完成机器人辅助经腹网片直肠固定术（RVMR）学习曲线并达到足够手术效果所需的手术例数。
对 2011 年至 2019 年间在一家三级盆底诊所由两位结直肠外科医生（A 和 B）进行的所有原发性 RVMR 进行回顾性分析。两位外科医生均具有腹腔镜直肠固定术的经验，但没有机器人手术经验。使用 LC-CUSUM 分析评估皮肤到皮肤的手术时间（OT）。使用 CUSUM 分析评估术中及术后并发症。
总共进行了 182 例（外科医生 A）和 91 例（外科医生 B）的 RVMR。两位外科医生的患者特征无明显差异。中位 OT 为 75 分钟（范围 46-155；外科医生 A）和 90 分钟（范围 63-139；外科医生 B）。外科医生 A 完成 OT 学习曲线需要 36 例，外科医生 B 需要 55 例。在完成学习曲线前后，术中及术后并发症的发生率均低于预先设定的可接受手术效果水平。
完成 RVMR 的学习曲线需要 36-55 例手术。在外科医生学习曲线的初期，机器人手术不会给患者带来任何额外的风险。
