Shahi Pratyush, Subramanian Tejas, Maayan Omri, Korsun Maximilian, Singh Sumedha, Araghi Kasra, Singh Nishtha, Asada Tomoyuki, Tuma Olivia, Vaishnav Avani, Sheha Evan, Dowdell James, Qureshi Sheeraz, Iyer Sravisht
Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2023 Nov 1;48(21):1517-1525. doi: 10.1097/BRS.0000000000004745. Epub 2023 Jun 7.
Retrospective review of prospectively collected data.
To analyze the learning curves of three spine surgeons for robotic minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Although the learning curve for robotic MI-TLIF has been described, the current evidence is of low quality with most studies being single-surgeon series.
Patients who underwent single-level MI-TLIF with three spine surgeons (years in practice: surgeon 1: 4, surgeon 2: 16, and surgeon 3: two) using a floor-mounted robot were included. Outcome measures were operative time, fluoroscopy time, intraoperative complications, screw revision, and patient-reported outcome measures. Each surgeon's cases were divided into successive groups of 10 patients and compared for differences. Linear regression and cumulative sum (CuSum) analyses were performed to analyze the trend and learning curve, respectively.
A total of 187 patients were included (surgeon 1: 45, surgeon 2: 122, and surgeon 3: 20). For surgeon 1, CuSum analysis showed a learning curve of 21 cases with the attainment of mastery at case 31. Linear regression plots showed negative slopes for operative and fluoroscopy time. Both learning phase and postlearning phase groups showed significant improvement in patient-reported outcome measures. For surgeon 2, CuSum analysis demonstrated no discernible learning curve. There was no significant difference between successive patient groups in either operative time or fluoroscopy time. For surgeon 3, CuSum analysis demonstrated no discernible learning curve. Even though the difference between successive patient groups was not significant, cases 11 to 20 had an average operative time of 26 minutes less than cases 1-10), suggesting an ongoing learning curve.
Surgeons who are well-experienced can be expected to have no or minimal learning curve for robotic MI-TLIF. Early attendings are likely to have a learning curve of around 21 cases with the attainment of mastery at case 31. Learning curve does not seem to impact clinical outcomes after surgery.
Level 3.
对前瞻性收集的数据进行回顾性分析。
分析三位脊柱外科医生进行机器人辅助微创经椎间孔腰椎椎间融合术（MI-TLIF）的学习曲线。
尽管已有关于机器人辅助MI-TLIF学习曲线的描述，但目前的证据质量较低，大多数研究为单医生系列研究。
纳入了由三位脊柱外科医生（从业年限：医生1为4年，医生2为16年，医生3为2年）使用落地式机器人进行单节段MI-TLIF手术的患者。观察指标包括手术时间、透视时间、术中并发症、螺钉翻修情况以及患者报告的结局指标。将每位医生的病例按连续10例患者为一组进行划分，并比较组间差异。分别进行线性回归分析和累积和（CuSum）分析以分析趋势和学习曲线。
共纳入187例患者（医生1：45例，医生2：122例，医生3：20例）。对于医生1，CuSum分析显示学习曲线为21例，在第31例时达到熟练水平。线性回归图显示手术时间和透视时间呈负斜率。学习阶段和学习后阶段的患者报告结局指标均有显著改善。对于医生2，CuSum分析未显示出明显的学习曲线。连续患者组之间的手术时间和透视时间均无显著差异。对于医生3，CuSum分析未显示出明显的学习曲线。尽管连续患者组之间的差异不显著，但第11至20例的平均手术时间比第1至1０例少26分钟，提示存在持续的学习曲线。
经验丰富的外科医生进行机器人辅助MI-TLIF时预计无学习曲线或学习曲线极小。初入行者可能有大约21例的学习曲线，在第31例时达到熟练水平。学习曲线似乎并不影响术后临床结局。
3级。
