Ryoo Da Y, Eskander Mariam F, Hamad Ahmad, Li Yaming, Cloyd Jordan, Manilchuk Andrei, Tsung Allan, Pawlik Timothy M, Dillhoff Mary, Schmidt Carl, Ejaz Aslam
The Ohio State University, Columbus, OH, USA.
West Virginia University, Morgantown, WV, USA.
HPB (Oxford). 2021 Oct;23(10):1550-1556. doi: 10.1016/j.hpb.2021.03.010. Epub 2021 Apr 8.
There is an associated lag in achieving competency for robotic pancreaticoduodenectomy (PD), resulting in a learning curve. We hypothesize that the reported learning curve can be mitigated through a comprehensive graduated training protocol.
All patients (n = 237) who underwent an open (n = 197, 83.1%) or robotic (n = 40, 16.9%) PD between 2015-2019 were identified at The Ohio State University. The learning curve for operative time and surgical failure (defined as conversion to open, blood transfusion, or Clavien-Dindo complication grade ≥3) was analyzed using a risk adjusted cumulative summation technique.
After 10 cases, operative time plateaued to a mean of 468.3 ± 96.3 minutes for robotic PD versus a mean of 332.5 ± 103.9 minutes for open PD (P < 0.001). There was no further apparent learning curve over time relative to rates of operative time or surgical failure. After propensity score-matching, patients undergoing robotic PD had a similar incidence of major complications, grade B/C postoperative pancreatic fistula, and delayed gastric emptying versus patients undergoing open PD (all P > 0.05).
Completion of a comprehensive procedure-specific robotic training protocol for PD mitigated the learning curve for this operative approach by shifting the curve into the training/simulation phase rather than the live operating phase. These data hold important implications for the future training and accreditation of surgeons embarking on robotic PD.
机器人胰十二指肠切除术（PD）在达到操作熟练程度方面存在相关延迟，从而形成了学习曲线。我们假设，通过全面的分级培训方案可以减轻所报道的学习曲线。
在俄亥俄州立大学确定了2015年至2019年间接受开放性（n = 197，83.1%）或机器人辅助（n = 40，16.9%）PD手术的所有患者（n = 237）。使用风险调整累积求和技术分析手术时间和手术失败（定义为转为开放手术、输血或Clavien-Dindo并发症分级≥3）的学习曲线。
10例手术后，机器人辅助PD的手术时间稳定在平均468.3±96.3分钟，而开放性PD的平均手术时间为332.5±103.9分钟（P < 0.001）。随着时间推移，相对于手术时间或手术失败率，没有进一步明显的学习曲线。在倾向得分匹配后，接受机器人辅助PD的患者与接受开放性PD的患者相比，主要并发症、B/C级术后胰瘘和胃排空延迟的发生率相似（所有P > 0.05）。
完成针对PD的全面的特定手术机器人培训方案，通过将曲线转移到培训/模拟阶段而非实际手术阶段，减轻了这种手术方式的学习曲线。这些数据对未来开展机器人辅助PD手术的外科医生的培训和认证具有重要意义。
