Department of Surgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
Biostatistics and Medical Informatics, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
J Robot Surg. 2023 Jun;17(3):1071-1076. doi: 10.1007/s11701-022-01514-6. Epub 2022 Dec 25.
The robotic platform can overcome technical difficulties associated with laparoscopic colon surgery. Transitioning from laparoscopic right colectomy with extracorporeal anastomosis (ECA) to robotic right colectomy with intracorporeal anastomosis (ICA) is associated with a learning phase. This study aimed at determining the length of this learning phase and its associated morbidity. We retrospectively analyzed all laparoscopic right colectomies with ECA (n = 38) and robotic right colectomies with ICA (n = 67) for (pre)malignant lesions performed by a single surgeon between January 2014 and December 2020. CUSUM-plot analysis of total procedure time was used for learning curve determination of robotic colectomies. Non-parametric tests were used for statistical analysis. Compared to laparoscopy, the learning phase robotic right colectomies (n = 35) had longer procedure times (p < 0.001) but no differences in anastomotic leakage rate, length of stay or 30-day morbidity. Conversion rate was reduced from 16 to 3 percent in the robotic group. This study provides evidence that robotic right colectomy with ICA can be safely implemented without increasing morbidity.
机器人平台可以克服腹腔镜结肠手术相关的技术难题。从腹腔镜右半结肠切除术联合体外吻合术（ECA）过渡到机器人右半结肠切除术联合体内吻合术（ICA）需要一个学习阶段。本研究旨在确定这个学习阶段的长度及其相关发病率。我们回顾性分析了 2014 年 1 月至 2020 年 12 月间由同一位外科医生完成的所有腹腔镜右半结肠切除术（ECA）（n=38）和机器人右半结肠切除术（ICA）（n=67）的（前）恶性病变。使用总手术时间的CUSUM-plot 分析来确定机器人结肠切除术的学习曲线。采用非参数检验进行统计学分析。与腹腔镜相比，机器人右半结肠切除术（n=35）的学习阶段手术时间更长（p<0.001），但吻合口漏率、住院时间或 30 天发病率没有差异。机器人组的转化率从 16%降至 3%。本研究提供了证据，表明机器人右半结肠切除术（ICA）可以安全实施，而不会增加发病率。
