Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Biochemistry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Anticancer Res. 2022 Aug;42(8):4111-4117. doi: 10.21873/anticanres.15909.
BACKGROUND/AIM: This study aimed to evaluate the learning curve and perioperative outcomes of robot-assisted hysterectomy (RAH).
We retrospectively analyzed data from 45 patients who underwent RAH using the da Vinci Xi surgical system. The learning curve was evaluated using the cumulative summation method. Demographic data and various perioperative parameters, including total operative time, docking time, and console time, were obtained from the medical records.
Cumulative summation analysis indicated that proficiency regarding hysterectomy time was reached after 33 cases. There were two unique phases of the learning curve for console time: the introduction phase identified by the bottom point in the curve, and the proficient phase, identified by an upward line after the bottom point in the curve. There were no significant differences between the two phases in terms of patient age and body mass index. Total operative time, docking time, and console time were significantly decreased in the proficient phase compared with those in the introduction phase. There was a significant reduction in blood loss during operation in the proficient phase. The perioperative complication rates were 12.1% in the introduction phase and 0% in the proficient phase (p=0.5606). No blood transfusion or conversion to laparotomy was required in either phase.
The introduction and proficient phases identified by cumulative summation analysis demonstrated progressive improvement of surgical performance in surgeons carrying out RAH.
背景/目的：本研究旨在评估达芬奇 Xi 手术系统辅助下的机器人全子宫切除术（RAH）的学习曲线和围手术期结果。
我们回顾性分析了 45 例行 RAH 的患者的数据。使用累积和法评估学习曲线。从病历中获取人口统计学数据和各种围手术期参数，包括总手术时间、对接时间和控制台时间。
累积和分析表明，在 33 例后达到了子宫切除术时间的熟练程度。控制台时间的学习曲线有两个独特的阶段：由曲线底部确定的引入阶段，以及曲线底部之后向上的熟练阶段。在两个阶段，患者的年龄和体重指数没有显著差异。与引入阶段相比，熟练阶段的总手术时间、对接时间和控制台时间显著缩短。熟练阶段的术中出血量显著减少。引入阶段和熟练阶段的围手术期并发症发生率分别为 12.1%和 0%（p=0.5606）。两个阶段均无需输血或中转开腹。
通过累积和分析确定的引入阶段和熟练阶段，展示了实施 RAH 的外科医生手术性能的逐步提高。
