Clinical Fellow Colorectal Surgery, University Hospital Coventry, Coventry, UK.
Robotic Research Fellow in Robotic Colorectal Surgery, University Hospital Coventry, Coventry, UK.
J Robot Surg. 2023 Feb;17(1):73-78. doi: 10.1007/s11701-022-01400-1. Epub 2022 Mar 24.
Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies. However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formalized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve. Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3 to 2.5 h, while total operative time dropped from 6 h to 5.5 h as the surgeon became more experienced; however, this was not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after 30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.
机器人结直肠手术可以实现更好的人体工程学效果、更优的牵拉力以及在骨盆狭窄解剖结构中进行精细的操作。近年来，机器人手术已广泛应用于所有盆腔手术，特别是在低位直肠恶性肿瘤中。然而，由于尚未形成规范化的培训途径，该手术在这一人群中的学习曲线尚不清楚。本研究通过评估与手术过程和患者预后相关的指标，观察了一位接受过腹腔镜培训的外科医生在使用达芬奇机器人系统进行安全有效的低位直肠和肛门恶性肿瘤切除手术方面的经验和学习曲线。对考文垂大学医院（UHCW）的机器人结直肠手术数据库进行了连续回顾性分析，共纳入 48 例连续病例，均由一位新获得资格的结直肠外科医生完成。通过记录每例手术的控制台和总手术时间以及评估切除的充分性来评估手术过程；此外，还分析了患者相关结局，包括术中及术后并发症，以评估学习曲线的差异。本研究纳入了一位外科医生连续完成的 48 例直肠乙状结肠切除术。这些病例按时间顺序分为四组，每组的人口统计学、肿瘤分期、肿瘤位置和手术复杂性具有可比性（平均年龄 65 岁，男性占 79%，女性占 29%）。结果显示，随着外科医生经验的增加，控制台时间从 3 小时降至 2.5 小时，总手术时间从 6 小时降至 5.5 小时，但这并未发现有统计学意义。此外，在研究期间，病理分期无显著差异。未观察到主要的术中及术后并发症，也未发生 30 天内死亡。此外，完成 30 例手术后，学习曲线进入平台期，提示机器人结直肠切除术所需技能的最高熟练度已达到峰值。机器人直肠手术的学习曲线较短且早期变平；在学习曲线期间，并发症发生率较低，且随着时间的推移继续下降。这表明，经过适当的培训和指导，新的结直肠外科医生可以在短时间内接受培训，进行选择性结直肠盆腔切除术。
