Meacci Elisa, Nachira Dania, Congedo Maria Teresa, Petracca-Ciavarella Leonardo, Vita Maria Letizia, Porziella Venanzio, Chiappetta Marco, Lococo Filippo, Tabacco Diomira, Triumbari Elizabeth Katherine Anna, Margaritora Stefano
Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy.
Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.
Front Surg. 2022 Aug 8;9:860899. doi: 10.3389/fsurg.2022.860899. eCollection 2022.
Robot-assisted thymectomy (RAT) has rapidly emerged as the preferred approach over open trans-sternal or video-assisted thoracoscopy for the surgical treatment of thymomas and non-thymomatous myasthenia gravis (MG). The aim of this study was to describe and discuss the learning curve (LC) of a single surgeon performing 113 consecutive RATs.
A single-center retrospective analysis of prospectively collected clinical data was performed on all patients who had been operated on by the same surgeon in an RAT setting between October 2013 and February 2020. The cumulative sum (CUSUM) analysis of the operative time was used to define the completion of the learning curve (CLC) in RAT. The CLC was separately calculated for myasthenic patients, non-myasthenic patients, and docking time.
In myasthenic patients, the CLC cut-off was found in 19 patients. Considering the CLC cut-off of 19 patients, the mean operative time in phase 1 (first 19 cases) was 229.79 ± 93.40 min, while it was 167.35 ± 41.63 min in phase 2 (last 51 cases), . In non-myasthenic patients, the CLC cut-off was found in 16 cases. The mean operative time in phase 1 (first 16 cases) was 277.44 ± 90.50 min, while it was 169.63 ± 61.10 min in phase 2 (last 27 cases), = 0.016. The LC for docking time was reached at 46 cases, recording a significant reduction of time after the first phase (28.09 ± 5.37 min vs. 19.75 ± 5.51 min, ). The intraoperative and 30-day mortality were null in all phases of the LC in both myasthenic and non-myasthenic patients. There were no differences between the two phases of the LC in terms of blood loss, duration of postoperative drainage, and postoperative stay in both myasthenic and non-myasthenic groups. However, significantly higher hospital readmission at 30 days post surgery was recorded for myasthenic patients operated on during the first phase of the LC (2 cases vs. 0, = 0.02).
According to our data, LC in RAT seems to be steep, and RAT confirms to be safe even before reaching CLC.
机器人辅助胸腺切除术（RAT）已迅速成为手术治疗胸腺瘤和非胸腺瘤性重症肌无力（MG）的首选方法，优于开放性胸骨切开术或电视辅助胸腔镜手术。本研究的目的是描述和讨论一位外科医生连续进行113例RAT手术的学习曲线（LC）。
对2013年10月至2020年2月在RAT手术环境下由同一位外科医生进行手术的所有患者进行单中心回顾性分析，该分析基于前瞻性收集的临床数据。采用手术时间的累积和（CUSUM）分析来确定RAT学习曲线的完成情况（CLC）。分别计算重症肌无力患者、非重症肌无力患者的CLC以及对接时间的CLC。
在重症肌无力患者中，19例患者达到了CLC截止点。考虑到19例患者的CLC截止点，第1阶段（前19例）的平均手术时间为229.79±93.40分钟，而第2阶段（后51例）为167.35±41.63分钟， 。在非重症肌无力患者中，16例患者达到了CLC截止点。第1阶段（前16例）的平均手术时间为277.44±90.50分钟，而第2阶段（后27例）为169.63±61.10分钟，P = 0.016。对接时间的LC在46例时达到，记录显示第一阶段后时间显著减少（28.09±5.37分钟对19.75±5.51分钟， ）。重症肌无力和非重症肌无力患者在LC的所有阶段术中及30天死亡率均为零。重症肌无力和非重症肌无力组在LC的两个阶段之间，在失血量、术后引流持续时间和术后住院时间方面没有差异。然而，在LC第一阶段接受手术的重症肌无力患者术后30天的再入院率明显更高（2例对0例，P = 0.02）。
根据我们的数据，RAT的LC似乎很陡，并且RAT在达到CLC之前就已证实是安全的。
