Cheah Yee L, Yang Hye Yeon, Simon Caroline J, Akoad Mohamed E, Connor Ashton A, Daskalaki Despoina, Han Dai Hoon, Brombosz Elizabeth W, Kim Jae K, Tellier Maureen A, Ghobrial R Mark, Gaber A Osama, Choi Gi Hong
Department of Surgery, JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas, USA.
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, South Korea.
Liver Transpl. 2025 Feb 1;31(2):190-200. doi: 10.1097/LVT.0000000000000480. Epub 2024 Oct 24.
Robotic surgery is an emerging minimally invasive option for living donor hepatectomy. Currently, there are no studies on the learning curve of robotic donor hepatectomy. Thus, we evaluated the learning curve for robotic donor right hepatectomy. We retrospectively reviewed prospectively collected data from consecutive living donors who underwent robotic hepatectomy at 2 specialized centers between 2016 and 2022. We estimated the number of cases required to achieve stable operating times for robotic donor right hepatectomy using cumulative sum (CUSUM) analysis. The complication rates were similar between the 2 centers (22.8% vs. 26.7%; p = 0.74). Most complications were graded as minor (70.4%). Analysis of the total operative time demonstrated that the learning curves reached a peak at the 17th case in center 1 and the 9th case in center 2. The average operation times for cases 1-17 versus 18-99 in center 1 were 603 versus 438 minutes ( p < 0.001), and cases 1-9 versus 10-15 in center 2 were 532 versus 418 minutes ( p = 0.002). Complication rates were lower after the learning curves were achieved, although this did not reach statistical significance. A comparison of outcomes between centers suggests that a standardized approach to this complex operation can be successfully transferred.
机器人手术是活体供肝肝切除术一种新兴的微创选择。目前，尚无关于机器人供肝肝切除术学习曲线的研究。因此，我们评估了机器人供体右半肝切除术的学习曲线。我们回顾性分析了2016年至2022年期间在2个专业中心接受机器人肝切除术的连续活体供体的前瞻性收集数据。我们使用累积和（CUSUM）分析估计了实现机器人供体右半肝切除术稳定手术时间所需的病例数。两个中心的并发症发生率相似（22.8%对26.7%；p = 0.74）。大多数并发症为轻度（70.4%）。对总手术时间的分析表明，学习曲线在中心1的第17例和中心2的第9例达到峰值。中心1中第1 - 17例与第18 - 99例的平均手术时间分别为603分钟和438分钟（p < 0.001），中心2中第1 - 9例与第10 - 15例的平均手术时间分别为532分钟和418分钟（p = 0.002）。达到学习曲线后并发症发生率较低，尽管这未达到统计学显著性。中心间结果的比较表明，这种复杂手术的标准化方法可以成功转移。
