Massari Federico, Kelly Gary Matthew Martin
DOCVET Clinica Veterinaria Nervianese, Via Rho 2, 20014 Nerviano, Italy.
Warren House Veterinary Centre, Lichfield Road, Walsall WS8 6LS, UK.
Animals (Basel). 2024 Jul 9;14(14):2016. doi: 10.3390/ani14142016.
Keyhole gastropexy is becoming increasingly popular, and the new development facilitates shorter surgical times. This paper reports on the learning curve in two-port laparoscopic gastropexy using FlexDex in a specialist's hands. FlexDex is a novel tool combining aspects of robotic surgery without requiring an expensive robot theatre setting.
Cohort of 16 dogs >25 kg and at high risk of gastric volvulus and dilatation (GDV) undergoing elective laparoscopic gastropexy were enrolled in the study consecutively from 5/2022 to 9/2023. All patients were operated on by one surgeon (FM), and surgical time was recorded to assess learning curve. Competence was defined as plateauing surgical time. Detailed follow-up at 1 day, 7 days, 14 days, 2 months, 6 months, and long-term was recorded for success rate and complications. Ultrasound examination was scheduled at 4-6-month review to confirm lasting success of the gastropexy.
All 16 patients were operated on successfully without any significant complications, as confirmed on the ultrasound. The surgical time of laparoscopic gastropexy reduced from 52 to 14 min (reduction of 38 min/73%) and reached plateau after the 12th case of the 16, making it a very steep learning curve in specialist hands. There were no serious complications, and success rate was 100% at the 6-month ultrasound assessment.
This is the first paper to report on the learning curve with the FlexDex device in a two-port laparoscopic gastropexy setting. It effectively halves the operating time to 30 min, making the surgery safer for the patient and more cost-efficient, without compromising the result.
钥匙孔胃固定术越来越受欢迎，新的进展使得手术时间更短。本文报告了在专家手中使用FlexDex进行双端口腹腔镜胃固定术的学习曲线。FlexDex是一种新型工具，融合了机器人手术的各个方面，无需昂贵的机器人手术室设置。
2022年5月至2023年9月，连续纳入16只体重超过25 kg且有胃扭转和扩张（GDV）高风险的犬，对其进行择期腹腔镜胃固定术。所有患者均由一名外科医生（FM）进行手术，并记录手术时间以评估学习曲线。能力定义为手术时间趋于平稳。记录术后1天、7天、14天、2个月、6个月及长期的详细随访情况，包括成功率和并发症。计划在4至6个月复查时进行超声检查，以确认胃固定术的持久成功。
所有16例患者均成功手术，超声检查证实无任何重大并发症。腹腔镜胃固定术的手术时间从52分钟缩短至14分钟（减少38分钟/73%），在16例中的第12例后达到平稳，这在专家手中是一条非常陡峭的学习曲线。无严重并发症，6个月超声评估时成功率为100%。
本文是首篇报道在双端口腹腔镜胃固定术环境下使用FlexDex设备学习曲线的文章。它有效地将手术时间减半至30分钟，使手术对患者更安全且更具成本效益，同时不影响手术效果。
