Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, FL, United States.
Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, FL, United States.
J Gastrointest Surg. 2024 Jul;28(7):1039-1044. doi: 10.1016/j.gassur.2024.04.012. Epub 2024 Apr 16.
The robotic platform is growing in popularity for hepatobiliary resections. Although the learning curve for basic competency has been reported, this is the first study to analyze the learning curve to achieve long-term mastery on a decade of experience with more than 500 robotic hepatectomies.
After institutional review board approval, 500 consecutive robotic hepatectomies from 2013 to 2023 were analyzed. Cumulative sum (CUSUM) analysis using operative duration was used to determine the learning curves.
A total of 500 patients were included in this study: composed of 230 men (46.0 %) and 270 women (54.0 %), aged 63.0 (61.0 ± 14.6) years, with a body mass index of 28.0 (29.0 ± 8.0) kg/m, a Model for End-Stage Liver Disease score of 7 (8 ± 3.0), an albumin-bilirubin score of -3.0 (-3.0 ± 0.6), and a Child-Pugh score of 5.0 (5.0 ± 0.7). Operative duration was 235.0 (260.1 ± 131.9) minutes, estimated blood loss was 100.0 (165.0 ± 208.1) mL, tumor size was 4.0 (5.0 ± 3.5) cm, and 94.0 % of patients achieved R0 margins. The length of hospital stay was 3.0 (4.0 ± 3.7) days, with 4.0 % of patient having major complications. Of note, 30-day readmission was 17.0 %, 30-day mortality was 2.0 %, and 90-day mortality was 3.0 %. On CUSUM analysis, the learning curve for minor resection (n = 215) was 75 cases, major resection (n = 154) was 100 cases, and technically challenging minor resection (n = 131) was 57 cases. Gaining more experience in performing surgical procedures resulted in shorter operative duration, lower blood loss, higher R0 resections, and lower major postoperative complications.
The minimum number of robotic hepatectomies to overcome the learning curves for mastery of minor, major, and technically challenging minor resections was significant. Our study can help guide surgeons in their early experience to optimize patient safety and outcomes.
机器人平台在肝胆切除术中越来越受欢迎。尽管已经报道了基本能力的学习曲线，但这是第一项分析长达十年经验的 500 多例机器人肝切除术以实现长期掌握的学习曲线的研究。
在获得机构审查委员会批准后，对 2013 年至 2023 年的 500 例连续机器人肝切除术进行了分析。使用手术时间的累积和 (CUSUM) 分析来确定学习曲线。
本研究共纳入 500 例患者：由 230 名男性（46.0%）和 270 名女性（54.0%）组成，年龄 63.0（61.0±14.6）岁，体重指数为 28.0（29.0±8.0）kg/m，终末期肝病模型评分 7（8±3.0），白蛋白-胆红素评分-3.0（-3.0±0.6），Child-Pugh 评分 5.0（5.0±0.7）。手术时间为 235.0（260.1±131.9）分钟，估计出血量为 100.0（165.0±208.1）mL，肿瘤大小为 4.0（5.0±3.5）cm，94.0%的患者达到 R0 切缘。住院时间为 3.0（4.0±3.7）天，4.0%的患者发生严重并发症。值得注意的是，30 天再入院率为 17.0%，30 天死亡率为 2.0%，90 天死亡率为 3.0%。在 CUSUM 分析中，小切除（n=215）的学习曲线为 75 例，大切除（n=154）为 100 例，技术上具有挑战性的小切除（n=131）为 57 例。在执行手术程序方面积累更多经验可缩短手术时间、降低出血量、提高 R0 切除率和降低术后严重并发症发生率。
克服小、大、技术上具有挑战性的小切除掌握的学习曲线所需的机器人肝切除术的最低数量具有显著意义。我们的研究可以帮助指导外科医生的早期经验，以优化患者的安全性和结果。
