Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Oper Neurosurg (Hagerstown). 2023 Dec 1;25(6):482-488. doi: 10.1227/ons.0000000000000862. Epub 2023 Aug 14.
Robot-assisted pedicle screw placement is associated with greater accuracy, reduced radiation, less blood loss, shorter hospital stays, and fewer complications than freehand screw placement. However, it can be associated with longer operative times and an extended training period. We report the initial experience of a surgeon using a robot system at an academic medical center.
We retrospectively reviewed all patients undergoing robot-assisted pedicle screw placement at a single tertiary care institution by 1 surgeon from 10/2017 to 05/2022. Linear regression, analysis of variance, and cumulative sum analysis were used to evaluate operative time learning curves. Operative time subanalyses for surgery indication, number of levels, and experience level were performed.
In total, 234 cases were analyzed. A significant 0.19-minute decrease in operative time per case was observed (r = 0.14, P = .03). After 234 operations, this translates to a reduction in 44.5 minutes from the first to last case. A linear relationship was observed between case number and operative time in patients with spondylolisthesis (-0.63 minutes/case, r = 0.41, P < .001), 2-level involvement (-0.35 minutes/case, r = 0.19, P = .05), and 4-or-more-level involvement (-1.29 minutes/case, r = 0.24, P = .05). This resulted in reductions in operative time ranging from 39 minutes to 1.5 hours. Continued reductions in operative time were observed across the learning, experienced, and expert phases, which had mean operative times of 214, 197, and 146 minutes, respectively ( P < .001). General proficiency in robot-assisted surgery was observed after the 20th case. However, 67 cases were required to reach mastery, defined as the inflection point of the cumulative sum curve.
This study documents the long-term learning curve of a fellowship-trained spine neurosurgeon. Operative time significantly decreased with more experience. Although gaining comfort with robotic systems may be challenging or require additional training, it can benefit surgeons and patients alike with continued reductions in operative time.
与徒手螺钉放置相比，机器人辅助椎弓根螺钉放置具有更高的准确性、更低的放射暴露、更少的失血量、更短的住院时间和更少的并发症。但是，它可能会导致手术时间延长和培训周期延长。我们报告了一位外科医生在学术医疗中心使用机器人系统的初步经验。
我们回顾性分析了 2017 年 10 月至 2022 年 5 月期间，一位外科医生在一家三级保健机构对 234 例接受机器人辅助椎弓根螺钉固定术的患者进行的手术。使用线性回归、方差分析和累积和分析来评估手术时间学习曲线。对手术适应证、手术节段数和经验水平进行手术时间亚分析。
共分析了 234 例患者。发现手术时间每例减少 0.19 分钟（r = 0.14，P =.03）。234 例手术后，第一例和最后一例手术的时间减少了 44.5 分钟。在伴有脊椎滑脱的患者中（-0.63 分钟/例，r = 0.41，P <.001）、涉及 2 个节段（-0.35 分钟/例，r = 0.19，P =.05）和涉及 4 个或更多节段（-1.29 分钟/例，r = 0.24，P =.05）的患者中，病例数与手术时间之间存在线性关系。这导致手术时间减少了 39 分钟至 1.5 小时不等。在学习、经验和专家阶段都观察到手术时间的持续减少，平均手术时间分别为 214 分钟、197 分钟和 146 分钟（P <.001）。在第 20 例手术之后，观察到机器人辅助手术的总体熟练程度。然而，需要 67 例才能达到掌握水平，即累积和曲线的拐点。
本研究记录了一名接受 fellowship 培训的脊柱神经外科医生的长期学习曲线。随着经验的增加，手术时间显著减少。虽然使用机器人系统可能具有挑战性或需要额外的培训，但随着手术时间的持续减少，它可以使外科医生和患者受益。
