Ahmad Ali, Freeman Hadley D, Corn Sarah D
Department of Surgical Oncology, School of Medicine-Wichita, University of Kansas, 818 N Emporia Ave, Wichita, KS, 67214, USA.
Surg Endosc. 2023 Apr;37(4):2915-2922. doi: 10.1007/s00464-022-09809-3. Epub 2022 Dec 12.
Robotic hepatectomy has gained increasing acceptance across the US. Although the robotic approach offers significant technical advantages, it is still bound by the individual surgeon's learning curve. Proficiency in this approach should theoretically lead to improved peri-operative outcomes.
Between 2017 and 2020, data on 148 consecutive robotic hepatectomies performed by a single surgeon was retrospectively analyzed. Using cumulative sum (CUSUM) method, intraoperative blood loss (EBL) and operative time were used to assess learning curves for robotic major (n = 58) and minor (n = 90) hepatectomy patients. Perioperative outcomes were compared in regards with proficiency.
Proficiency for robotic major and minor hepatectomy was achieved after 22 cases and 34 cases, respectively. No significant differences were observed in patient demographics or tumor characteristics. For robotic major hepatectomy, when compared to early experience, proficiency was associated with a significant improvement in mean EBL (242 mL vs 118 mL, p = 0.0004), operative time (330 min vs 247 min, p = 0.0002), decreased overall complication rate (23% vs 3%, p = 0.039), and length of hospital stay (5.7 days vs 4.1 days, p = 0.004). No difference in conversion rate, mortality or 30 day readmission was seen. For robotic minor hepatectomy, proficiency was associated with significantly decreased mean EBL (115 mL vs 54 mL, p = 0.005), operative time (168 vs 125 min, p = 0.014), and length of hospital stay (2.8 days vs 2.1 days, p = 0.021). No difference was observed in conversion rate, overall complications, mortality or 30 day readmission.
In the modern era, robotic hepatectomy offers a safe approach with excellent perioperative outcomes. Post learning curve proficiency is associated with significant improvements in perioperative outcomes in both major and minor hepatectomy. Results from our study can serve as a guide to surgeons and programs looking to adopt this technique.
机器人肝切除术在美国越来越被广泛接受。尽管机器人手术方法具有显著的技术优势，但它仍受限于外科医生个人的学习曲线。从理论上讲，熟练掌握这种方法应该能改善围手术期的结果。
回顾性分析了2017年至2020年间由一名外科医生连续进行的148例机器人肝切除术的数据。使用累积和（CUSUM）方法，采用术中失血量（EBL）和手术时间来评估机器人肝大部切除术（n = 58）和肝小部切除术（n = 90）患者的学习曲线。并根据熟练程度比较围手术期结果。
分别在22例和34例手术后，术者熟练掌握了机器人肝大部切除术和肝小部切除术。患者的人口统计学特征或肿瘤特征方面未观察到显著差异。对于机器人肝大部切除术，与早期经验相比，熟练操作时平均EBL显著改善（242 mL对118 mL，p = 0.0004），手术时间（330分钟对247分钟，p = 0.0002），总体并发症发生率降低（23%对3%，p = 0.039），住院时间缩短（5.7天对4.1天，p = 0.004）。在转化率、死亡率或30天再入院率方面未见差异。对于机器人肝小部切除术，熟练操作与平均EBL显著降低（115 mL对54 mL，p =
