Second Department of Gastrointestinal, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 May 28;48(5):716-724. doi: 10.11817/j.issn.1672-7347.2023.220635.
Da Vinci robot technology is widely used in clinic,with minimally invasive surgery development. This study aims to explore the possible influence of advanced surgical robotics on the surgery learning curve by comparing the initial clinical learning curves of 2 different surgical techniques: robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG).
From September 2017 to December 2020, a chief surgeon completed a total of 108 cases of radical gastric cancer from the initial stage, including 27 cases of RAG of the Da Vinci Si robotic system (RAG group) and 81 cases of LAG (LAG group). The lymph node of gastric cancer implemented by the Japanese treatment guidelines of gastric cancer. The surgical results, postoperative complications, oncology results and learning curve were analyzed.
There was no significant difference in general data, tumor size, pathological grade and clinical stage between the 2 groups (>0.05). The incidence of serious complications in the RAG group was lower than the LAG group (=0.003). The intraoperative blood loss in the RAG group was lower than that in the LAG group (=0.046). The number of lymph nodes cleaned in the RAG group was more (=0.003), among which there was obvious advantage in lymph node cleaning in the No.9 group (=0.038) and 11p group (=0.015). The operation time of the RAG group was significantly longer than the LAG group (=0.015). The analysis of learning curve found that the cumulative sum analysis (CUSUM) value of the RAG group decreased from the 10th case, while the CUSUM of the LAG group decreased from the 28th case. The learning curve of the RAG group had fewer closing cases than that of the LAG group. The unique design of the surgical robot might help to improve the surgical efficiency and shorten the surgical learning curve.
Advanced robotics helps experienced surgeons quickly learn to master RAG skills. With the help of robotics, RAG are superior to LAG in No.9 and 11p lymph node dissection and surgical trauma reduction. RAG can clear more lymph nodes than LAG, and has better perioperative effect.
达芬奇机器人技术在微创外科发展中得到广泛应用。本研究旨在通过比较两种不同手术技术的初步临床学习曲线，即机器人辅助胃切除术（RAG）和腹腔镜辅助胃切除术（LAG），探讨先进的手术机器人对手术学习曲线的可能影响。
自 2017 年 9 月至 2020 年 12 月，一位首席外科医生完成了总共 108 例早期胃癌根治术，其中达芬奇 Si 机器人系统 27 例 RAG（RAG 组）和 81 例 LAG（LAG 组）。胃癌的淋巴结清扫实施日本胃癌治疗指南。分析手术结果、术后并发症、肿瘤学结果和学习曲线。
两组一般资料、肿瘤大小、病理分级、临床分期比较差异无统计学意义（>0.05）。RAG 组严重并发症发生率低于 LAG 组（=0.003）。RAG 组术中出血量低于 LAG 组（=0.046）。RAG 组清扫的淋巴结数量较多（=0.003），其中第 9 组（=0.038）和 11p 组（=0.015）的淋巴结清扫有明显优势。RAG 组的手术时间明显长于 LAG 组（=0.015）。学习曲线分析发现，RAG 组的累积和分析（CUSUM）值从第 10 例开始下降，而 LAG 组的 CUSUM 值从第 28 例开始下降。RAG 组的学习曲线比 LAG 组的关闭病例数少。手术机器人的独特设计可能有助于提高手术效率并缩短手术学习曲线。
先进的机器人技术有助于经验丰富的外科医生快速掌握 RAG 技能。在机器人的帮助下，RAG 在第 9 组和 11p 淋巴结清扫和减少手术创伤方面优于 LAG。RAG 可以清除比 LAG 更多的淋巴结，并且具有更好的围手术期效果。
