Calleja Rafael, Medina-Fernández Francisco Javier, Vallejo-Lesmes Ana, Durán Manuel, Torres-Tordera Eva M, Díaz-López César A, Briceño Javier
General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain.
Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.
Updates Surg. 2023 Dec;75(8):2179-2189. doi: 10.1007/s13304-023-01655-9. Epub 2023 Oct 24.
As a novel procedure becomes more and more used, knowledge about its learning curve and its impact on outcomes is useful for future implementations. Our aim is (i) to identify the phases of the robotic rectal surgery learning process and assess the safety and oncological outcomes during that period, (ii) to compare the robotic rectal surgery learning phases outcomes with laparoscopic rectal resections performed before the implementation of the robotic surgery program. We performed a retrospective study, based on a prospectively maintained database, with methodological quality assessment by STROBE checklist. All the procedures were performed by the same two surgeons. A total of 157 robotic rectal resections from June 2018 to January 2022 and 97 laparoscopic rectal resections from January 2018 to July 2019 were included. The learning phase was completed at case 26 for surgeon A, 36 for surgeon B, and 60 for the center (both A & B). There were no differences in histopathological results or postoperative complications between phases, achieving the same ratio of mesorectal quality, circumferential and distal resection margins as the laparoscopic approach. A transitory increase of major complications and anastomotic leakage could occur once overcoming the learning phase, secondary to the progressive complexity of cases. Robotic rectal cancer surgery learning curve phases in experienced laparoscopic surgeons was completed after 25-35 cases. Implementation of a robotic rectal surgery program is safe in oncologic terms, morbidity, mortality and length of stay.
随着一种新手术越来越多地被采用，了解其学习曲线及其对手术结果的影响对于未来的应用很有帮助。我们的目的是：（i）确定机器人直肠手术学习过程的阶段，并评估该期间的安全性和肿瘤学结果；（ii）将机器人直肠手术学习阶段的结果与在机器人手术项目实施前进行的腹腔镜直肠切除术的结果进行比较。我们基于一个前瞻性维护的数据库进行了一项回顾性研究，并通过STROBE清单进行方法学质量评估。所有手术均由同两位外科医生进行。纳入了2018年6月至2022年1月的157例机器人直肠切除术以及2018年1月至2019年7月的97例腹腔镜直肠切除术。外科医生A在第26例、外科医生B在第36例、中心（A和B）在第60例完成学习阶段。各阶段之间在组织病理学结果或术后并发症方面没有差异，直肠系膜质量、环周和远端切缘的比例与腹腔镜手术方法相同。一旦克服学习阶段，由于病例逐渐复杂，主要并发症和吻合口漏可能会暂时增加。经验丰富的腹腔镜外科医生进行机器人直肠癌手术的学习曲线阶段在25 - 35例手术后完成。从肿瘤学角度、发病率、死亡率和住院时间来看，实施机器人直肠手术项目是安全的。
