Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Cancer Treat Res Commun. 2021;27:100362. doi: 10.1016/j.ctarc.2021.100362. Epub 2021 Apr 2.
Robotic assistance in lung lobectomy has been suggested to enhance the adoption of minimally invasive techniques among surgeons. However, little is known of learning curves in different minimally invasive techniques. We studied learning curves in robotic-assisted versus video- assisted lobectomies for lung cancer.
A single surgeon performed his first 75 video-assisted thoracic surgery (VATS) lobectomies from April 2007 to November 2012, and his 75 first robotic-assisted thoracic surgery (RATS) lobectomies between August 2011 and May 2018. A retrospective chart review was done. Cumulative sum (CUSUM) analysis was used to identify the learning curve.
No operative deaths occurred for VATS patients or RATS patients. Conversion-to-open rate was significantly lower in the RATS group (2.7% vs. 13.3%, p = 0.016). Meanwhile, 90-day mortality (1.3% vs. 5.3%, p = 0.172), postoperative complications (24% vs. 24%, p = 0.999), re- operation rates (4% vs. 5.3%, p = 0.688), operation time (170±56 min vs. 178±66 min, p = 0.663) and length of stay (8.9 ± 7.9 days vs. 8.2 ± 5.8 days, p = 0.844) were similar between the two groups. Based on CUSUM analysis, learning curves were similar for both procedures, although slightly shorter for RATS (proficiency obtained with 53 VATS cases vs. 45 RATS cases, p = 0.198).
Robotic-assisted thoracoscopic lung lobectomy can be implemented safely and efficiently in an expert center with earlier experience in VATS lobectomies. However, there seems to be a learning curve of its own despite the surgeon's previous experience in conventional thoracoscopic surgery.
机器人辅助肺叶切除术有助于提高外科医生对微创技术的接受程度。然而，对于不同微创技术的学习曲线知之甚少。我们研究了机器人辅助与电视辅助肺叶切除术治疗肺癌的学习曲线。
一位外科医生于 2007 年 4 月至 2012 年 11 月完成了他的前 75 例电视辅助胸腔镜手术（VATS）肺叶切除术，于 2011 年 8 月至 2018 年 5 月完成了他的前 75 例机器人辅助胸腔镜手术（RATS）肺叶切除术。进行了回顾性图表审查。累积和（CUSUM）分析用于确定学习曲线。
VATS 患者和 RATS 患者均无手术死亡。RATS 组中转开胸率明显较低（2.7%比 13.3%，p=0.016）。同时，90 天死亡率（1.3%比 5.3%，p=0.172）、术后并发症（24%比 24%，p=0.999）、再次手术率（4%比 5.3%，p=0.688）、手术时间（170±56 分钟比 178±66 分钟，p=0.663）和住院时间（8.9±7.9 天比 8.2±5.8 天，p=0.844）在两组之间相似。基于 CUSUM 分析，两种手术的学习曲线相似，尽管 RATS 稍短（53 例 VATS 病例获得熟练程度，45 例 RATS 病例获得熟练程度，p=0.198）。
在有 VATS 肺叶切除术经验的专家中心，机器人辅助胸腔镜肺叶切除术可以安全有效地实施。然而，尽管外科医生之前有常规胸腔镜手术经验，但似乎也有自己的学习曲线。
