Niemann Britney, Kenney Christopher, Wallis Marsh J, Schmidt Carl, Boone Brian A
Division of Surgical Oncology, Department of Surgery, West Virginia University.
Res Sq. 2024 Apr 24:rs.3.rs-4271384. doi: 10.21203/rs.3.rs-4271384/v1.
Robotic surgery is increasingly utilized in hepatopancreatobiliary (HPB) surgery, but the learning curve is a substantial obstacle hindering implementation. Comprehensive robotic training can help to surmount this obstacle; however, despite the expansion of robotic training into residency and fellowship programs, limited data is available about how this translates into successful incorporation in faculty practice.
All operations performed during the first three years of practice of a complex general surgical oncology-trained surgical oncologist at a tertiary care academic institution were retrospectively reviewed. The surgeon underwent comprehensive robotic training during residency and fellowship.
137 HPB operations were performed during the initial three years of practice. Over 80% were performed robotically each year across a spectrum of HPB procedures with a 6% conversion rate. Median operative time, the optimal metric for operative proficiency and evaluation for a learning curve, was similar throughout the study period for each major operation and below several reported optimized operative times. Major complications were similar across the experience and comparable to published series.
Comprehensive robotic training in residency and fellowship as well as a dedicated, well-trained operative team allows for early attainment of optimized outcomes in a new HPB robotic practice.
机器人手术在肝胰胆（HPB）手术中的应用日益广泛，但学习曲线是阻碍其实施的一个重大障碍。全面的机器人培训有助于克服这一障碍；然而，尽管机器人培训已扩展到住院医师和专科培训项目，但关于这如何转化为成功融入教师实践的数据有限。
对一位在三级医疗学术机构接受复杂普通外科肿瘤学培训的外科肿瘤学家执业的前三年中进行的所有手术进行回顾性审查。该外科医生在住院医师和专科培训期间接受了全面的机器人培训。
在执业的最初三年中进行了137例HPB手术。每年超过80%的手术通过机器人进行，涵盖一系列HPB手术，转化率为6%。中位手术时间是衡量手术熟练程度和学习曲线评估的最佳指标，在整个研究期间，每种主要手术的中位手术时间相似，且低于一些报道的优化手术时间。不同经验阶段的主要并发症相似，与已发表系列相当。
住院医师和专科培训中的全面机器人培训以及一个专注、训练有素的手术团队，使得在新的HPB机器人手术实践中能够早期获得优化结果。
