Division of Surgical Oncology, Department of Surgery, West Virginia University, One Medical Center Drive, PO Box 9238 HSCS, Morgantown, WV, 26506, USA.
Cancer Cell Biology, West Virginia University, Morgantown, WV, USA.
J Robot Surg. 2024 Jun 15;18(1):253. doi: 10.1007/s11701-024-02011-8.
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 are available about how this translates into successful incorporation in faculty practice. All operations performed during the first three years of practice of a 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, a 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 time benchmarks. The major complications, defined as a Clavien-Dindo of 3 or more, 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.
机器人手术在肝胆胰外科（HPB）中越来越多地被应用，但其学习曲线是阻碍其实施的一个重要障碍。全面的机器人培训可以帮助克服这一障碍；然而，尽管机器人培训已经扩展到住院医师和专科医师培训计划中，但关于这如何转化为在教职员工实践中的成功应用的数据有限。回顾了一名在三级护理学术机构工作的外科肿瘤学家在实践的头三年中所进行的所有手术。该外科医生在住院医师和专科医师培训期间接受了全面的机器人培训。在最初的三年实践中进行了 137 例 HPB 手术。每年有超过 80%的手术是通过机器人完成的，涵盖了一系列 HPB 手术，转化率为 6%。手术时间中位数是衡量手术熟练程度和学习曲线的指标，在研究期间的每个主要手术中都相似，并且低于几个已报道的优化手术时间基准。主要并发症定义为 Clavien-Dindo 分级 3 或更高，在整个经验中相似，与已发表的系列相似。在住院医师和专科医师培训中进行全面的机器人培训以及一支专门的、训练有素的手术团队，可以使新的 HPB 机器人手术实践能够早期获得优化的结果。
