Department of Surgery, Division of Surgical Oncology, Duke University, Medical Center 3247, 456E Seeley G. Mudd Bldg, Durham, NC, 27710, USA.
Department of Statistical Science, Duke University, Durham, NC, 27710, USA.
J Robot Surg. 2024 Mar 16;18(1):126. doi: 10.1007/s11701-023-01746-0.
Robotic pancreaticoduodenectomy (RPD) has a learning curve of approximately 30-250 cases to reach proficiency. The learning curve for laparoscopic pancreaticoduodenectomy (LPD) at Duke University was previously defined as 50 cases. This study describes the RPD learning curve for a single surgeon following experience with LPD. LPD and RPD were retrospectively analyzed. Continuous pathologic and perioperative metrics were compared and learning curve were defined with respect to operative time using CUSUM analysis. Seventeen LPD and 69 RPD were analyzed LPD had an inverted learning curve possibly accounting for proficiency attained during the surgeon's fellowship and acquisition of new skills coinciding with more complex patient selection. The learning curve for RPD had three phases: accelerated early experience (cases 1-10), skill consolidation (cases 11-40), and improvement (cases 41-69), marked by reduction in operative time. Compared to LPD, RPD had shorter operative time (379 vs 479 min, p < 0.005), less EBL (250 vs 500, p < 0.02), and similar R0 resection. RPD also had improved LOS (7 vs 10 days, p < 0.007), and lower rates of surgical site infection (10% vs 47%, p < 0.002), DGE (19% vs 47%, p < 0.03), and readmission (13% vs 41%, p < 0.02). Experience in LPD may shorten the learning curve for RPD. The gap in surgical quality and perioperative outcomes between LPD and RPD will likely widen as exposure to robotics in General Surgery, Hepatopancreaticobiliary, and Surgical Oncology training programs increase.
机器人胰十二指肠切除术(RPD)的熟练程度需要大约 30-250 例才能达到。杜克大学之前将腹腔镜胰十二指肠切除术(LPD)的学习曲线定义为 50 例。本研究描述了一位外科医生在接受 LPD 经验后进行 RPD 的学习曲线。回顾性分析 LPD 和 RPD。连续的病理和围手术期指标进行比较,并使用 CUSUM 分析针对手术时间定义学习曲线。分析了 17 例 LPD 和 69 例 RPD,LPD 呈倒学习曲线,可能是由于外科医生的奖学金期间达到的熟练程度以及与更复杂的患者选择同时获得的新技能。RPD 的学习曲线有三个阶段:加速早期经验(病例 1-10)、技能巩固(病例 11-40)和改进(病例 41-69),以手术时间减少为标志。与 LPD 相比,RPD 的手术时间更短(379 对 479 分钟,p<0.005)、EBL 更少(250 对 500,p<0.02),且 R0 切除率相似。RPD 还改善了 LOS(7 对 10 天,p<0.007),降低了手术部位感染率(10%对 47%,p<0.002)、DGE(19%对 47%,p<0.03)和再入院率(13%对 41%,p<0.02)。LPD 的经验可能会缩短 RPD 的学习曲线。随着普通外科、肝胆胰和外科肿瘤学培训计划中对机器人的接触增加,LPD 和 RPD 之间的手术质量和围手术期结果差距可能会扩大。
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