Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
Minim Invasive Ther Allied Technol. 2022 Aug;31(6):954-961. doi: 10.1080/13645706.2022.2045325. Epub 2022 Feb 28.
The primary goal is to analyze the learning curve of surgical parameters (docking, operation and console time) between multiport and single-site robotic hysterectomy techniques, performed by expert laparoscopic surgeons. The trial is a retrospective analysis of 229 patients enrolled between 2010 and 2018 who underwent robotic hysterectomies with bilateral salpingo-oophorectomies (HBSO) for gynecological diseases. Surgical parameters, learning curve and surgical outcomes were analyzed in order to evaluate the transition from multiport to single-site programs, performed by non-expert surgeons using the multiport technique. All surgical times (total, docking and console time) were shorter in the multiport robotic hysterectomy group, while the intraoperative complication rate was lower in the robotic single-site hysterectomy group ( = 0.007). The learning curve of operative, console and docking time significantly decreased more in the robotic-single site hysterectomy group, than in the multiport robotic hysterectomy group over time ( value < 0.001). The direct transition from the laparoscopy program to the single-site approach is feasible and effective in HBSO performed by expert laparoscopic surgeons. The learning curve of robotic single-site hysterectomy shows that the proficiency in this technique requires more cases than the multiport robotic hysterectomy cases and needs more time to fit the surgical step to the single-site platform.
主要目标是分析由腹腔镜专家执行的多孔和单孔机器人子宫切除术技术的手术参数（对接、操作和控制台时间）的学习曲线。该试验是对 2010 年至 2018 年间 229 名接受双侧输卵管卵巢切除术（HBSO）治疗妇科疾病的机器人子宫切除术患者的回顾性分析。为了评估非专家外科医生使用多孔技术从多孔向单孔方案的过渡，分析了手术参数、学习曲线和手术结果。多孔机器人子宫切除术组的所有手术时间（总时间、对接时间和控制台时间）均较短，而机器人单孔子宫切除术组的术中并发症发生率较低（=0.007）。随着时间的推移，机器人单孔子宫切除术组的手术、控制台和对接时间的学习曲线明显比多孔机器人子宫切除术组下降得更快（<0.001）。由腹腔镜专家进行的 HBSO 中，直接从腹腔镜方案过渡到单孔方法是可行且有效的。机器人单孔子宫切除术的学习曲线表明，该技术的熟练程度需要比多孔机器人子宫切除术更多的病例，并且需要更多的时间将手术步骤适应于单孔平台。
