Haywood Nathan, Scott Joshua, Zhang Aimee, Hallowell Peter, Schirmer Bruce
Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA.
Department of General Surgery, Sheridan Memorial Hospital, Sheridan, WY, USA.
Surg Endosc. 2023 Dec;37(12):9393-9398. doi: 10.1007/s00464-023-10402-5. Epub 2023 Sep 1.
Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs.
De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated.
MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01].
Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.
在过去十年中，机器人手术呈指数级增长。很少有研究评估机器人技术在微创手术（MIS）专科培训项目中的影响。我们研究的目的是检查和描述MIS专科培训项目中机器人手术的近期趋势。
对2010年至2021年来自专科医师协会的匿名病例记录数据进行评估。评估随时间推移在机器人辅助下进行的手术百分比，并与腹腔镜手术和开放手术经验进行比较。病例记录按手术类别（如减肥手术、疝气手术、前肠手术）进一步分层，并评估每个类别的机器人手术经验随时间的变化。根据机器人使用百分比对项目进行分层，并评估每个四分位数内随时间的经验。
在研究期间，拥有机器人平台的MIS专科培训项目从45.1%（51/113）增加到90.4%（123/136）。机器人手术病例的百分比从2.0%（1127/56033）增加到23.2%（16139/69496），而腹腔镜手术病例从80.2%（44954/56033）下降到65.3%（45356/69496）。疝气和结直肠手术类别的机器人使用增加最多[疝气：0.7%（62/8614）至38.4%（4661/12135）；结直肠：4.2%（116/2747）至31.8%（666/2094）]。按机器人利用率百分比分层时，当前（2020 - 2021年）处于第95百分位数以上的项目进行了21.8%（3523/16139）的机器人手术，处于第50百分位数以上的项目进行了所有机器人病例的90.0%（14533/16139）。从2010年到2021年，每位MIS专科医师进行的机器人手术病例中位数显著增加[0（0 - 6）至72.5（17.8 - 171.5），p < 0.01]。
在过去十年中，MIS专科培训项目中机器人的使用大幅增长，但腹腔镜手术和开放手术经验仍然丰富。最繁忙的50%机器人项目进行了超过90%的机器人培训病例，存在不平衡。MIS项目中的经验差异很大，学员应仔细检查项目病例记录以确认兴趣一致。
