Wang Lun, Yu Yang, Wang Jinfa, Li Shixing, Jiang Tao
Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
Front Surg. 2022 Jul 22;9:969418. doi: 10.3389/fsurg.2022.969418. eCollection 2022.
The robotic surgical system is being used in various bariatric procedures. However, only a few studies with very small sample size are present on robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). Moreover, to date, the learning curve of robotic SADI-S has been poorly evaluated yet.
This retrospective study aimed to estimate the learning curve of robotic SADI-S.
102 consecutive patients who underwent robotic SADI-S between March 2020 and December 2021 were included. Textbook outcome standard was performed to comprehensively evaluate clinical outcome of robotic SADI-S. Based on the textbook outcome, we evaluated the learning curve of robotic SADI-S by the cumulative sum (CUSUM) method.
The mean operative time was 186.13 ± 36.91 min. No conversion to laparotomy or deaths occurred during the study period. The rate of complications was 6.9% ( = 7), of which major complications were identified in 2.9% ( = 3), including 2 gastric leakages and 1 respiratory failure. A total of 60 patients reached the textbook outcome standard. The rate of textbook outcome was positive and was steadily increasing after the number of surgical cases accumulated to the 58th case. Taking the 58th case as the boundary, all the patients were divided into the learning stage group (the first 58 patients) and mastery stage group (the last 44 patients). The rate of complications, proportion of abdominal drainage tubes and postoperative hospital stay were significantly higher in the learning stage group compared with the mastery stage group (< 0.05). No significant difference was observed between the two groups in terms of patient demographic data, operative times, reoperations and readmission.
Robotic SADI-S is a feasible and reproducible surgical technique with a learning curve of 58 cases.
机器人手术系统正应用于各种减肥手术。然而，关于机器人单吻合口十二指肠-回肠旁路术联合袖状胃切除术（SADI-S）的研究很少，且样本量非常小。此外，迄今为止，机器人SADI-S的学习曲线尚未得到充分评估。
本回顾性研究旨在评估机器人SADI-S的学习曲线。
纳入2020年3月至2021年12月期间连续接受机器人SADI-S手术的102例患者。采用教科书式结局标准全面评估机器人SADI-S的临床结局。基于教科书式结局，我们采用累积和（CUSUM）方法评估机器人SADI-S的学习曲线。
平均手术时间为186.13±36.91分钟。研究期间无转为开腹手术或死亡病例。并发症发生率为6.9%（n=7），其中严重并发症发生率为2.9%（n=3），包括2例胃漏和1例呼吸衰竭。共有60例患者达到教科书式结局标准。教科书式结局率呈阳性，在手术病例数累积到第58例后稳步上升。以第58例为界，将所有患者分为学习阶段组（前58例患者）和熟练阶段组（后44例患者）。学习阶段组的并发症发生率、腹腔引流管留置比例和术后住院时间均显著高于熟练阶段组（P<0.05）。两组患者的人口统计学数据、手术时间、再次手术和再次入院情况无显著差异。
机器人SADI-S是一种可行且可重复的手术技术，学习曲线为58例。
