Kudsi Omar Yusef, Gokcal Fahri, Bou-Ayash Naseem, Crawford Allison S
Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.
University of Massachusetts Medical School, Worcester, MA, USA.
Surg Endosc. 2022 May;36(5):3480-3488. doi: 10.1007/s00464-021-08669-7. Epub 2021 Sep 7.
Despite heightened interest in robotic transversus abdominis release (rTAR), concerns over its steep learning curve (LC) and associated challenges may limit its adoption. This study defines the operative time and morbidity-based LC of a single surgeon's experience with rTAR.
A retrospective analysis of patients undergoing rTAR over an 8-year period was conducted. Consecutive ventral and incisional hernia repairs were stratified into four sub-categories based on bilaterality and complexity, with complex hernias being defined as those > 10 cm. Cumulative sum analyses (CUSUM) were used to evaluate skin-to-skin time and morbidity LCs.
This study included a total of 156 rTARs with a mean skin-to-skin time of 222.8 min. Mean skin-to-skin times (min) for sub-categories were as follows: unilateral non-complex (137.6), bilateral non-complex (206.8), unilateral complex (241.9), and bilateral complex (298.6). The CUSUM-LC was obtained by summing the differences between each procedure's operative time and its sub-category mean, revealing a quadratic best-fit line maximum at case 49 and a transition point between early and late phases at case 75. Although skin-to-skin times between early and late phases did not differ significantly (235.3 vs 211.2, respectively; p = 0.12), a significant difference was found in console times. Overall postoperative complications also decreased significantly from early to late phases (41.3% vs 25.9%; p = 0.041). Postoperative complications were predicted by a history of wound infection (c = 0.61).
This study reveals that the rTAR LC was overcome between 49 and 75 cases, after which, console time and postoperative complications decreased significantly.
尽管对机器人腹横肌松解术（rTAR）的兴趣日益浓厚，但对其陡峭的学习曲线（LC）及相关挑战的担忧可能会限制其应用。本研究界定了一位外科医生开展rTAR的基于手术时间和发病率的学习曲线。
对8年间接受rTAR治疗的患者进行回顾性分析。连续的腹侧和切口疝修补术根据双侧性和复杂性分为四个亚类，复杂疝定义为直径大于10厘米的疝。采用累积和分析（CUSUM）评估皮肤切开至缝合时间和发病率学习曲线。
本研究共纳入156例rTAR手术，平均皮肤切开至缝合时间为222.8分钟。各亚类的平均皮肤切开至缝合时间（分钟）如下：单侧非复杂疝（137.6）、双侧非复杂疝（206.8）、单侧复杂疝（241.9）和双侧复杂疝（298.6）。CUSUM学习曲线是通过累加每个手术的手术时间与其亚类平均值之间的差异得出的，显示在第49例时二次拟合线达到最大值，在第75例时为早期和晚期的转折点。尽管早期和晚期的皮肤切开至缝合时间无显著差异（分别为235.3分钟和211.2分钟；p = 0.12），但在控制台操作时间上发现有显著差异。从早期到晚期，总体术后并发症也显著减少（41.3%对25.9%；p = 0.041）。伤口感染史可预测术后并发症（c = 0.61）。
本研究表明，在完成49至75例手术后，rTAR的学习曲线被克服，此后，控制台操作时间和术后并发症显著减少。
