Celotto Francesco, Ramacciotti Niccolò, Danieli Giacomo, Pinto Federico, Spolverato Gaya, Morelli Luca, Bianco Francesco Maria
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Surg Innov. 2025 Jun;32(3):253-261. doi: 10.1177/15533506251314605. Epub 2025 Jan 26.
BackgroundTransabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times.MethodsThe operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed.ResultsThe DT has remained constant over time ( > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; = 0.08). In FCT and CT, 3 phases were identified in which times remained stable ( > 0.9 and = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding.ConclusionsThe learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.
背景
目前，很少有中心开展使用达芬奇单孔机器人（SP-TAPP）进行经腹腹膜前腹股沟疝修补术。我们旨在通过分析手术时间来确定SP-TAPP的学习曲线。
方法
回顾性分析2019年至2024年期间进行的122例SP-TAPP的手术时间。分析以下阶段：对接时间（DT）；机器人前时间（PRT，从皮肤切口到侧台车放置）；皮瓣关闭时间（FCT）；控制台时间（CT）和总时间（OT）。采用累积和分析（CUSUM）来分析学习曲线。分析手术和30天的结果。
结果
DT随时间保持恒定（>0.9）。PRT分为3个阶段，n1 = 5，n2 = 95，n3 = 4，其中时间逐渐减少（14.8分钟对11.9分钟对6.8分钟；P = 0.08）。在FCT和CT中，确定了3个阶段，其中时间保持稳定（>0.9和P = 0.7）。OT的CUSUM分析确定了3个阶段，n1 = 13，n2 = 100，n3 = 9，其中时间逐渐减少（82分钟对72分钟对62分钟；P = 0.3）。除估计失血量外，并发症和早期手术结果的分析没有差异，尽管这是一个临床意义不大的发现。
结论
SP-TAPP的学习曲线很快，并且表明对于有经验的外科医生来说，技术技能如何在多端口平台和达芬奇单孔机器人系统之间转移。与多端口系统相比，PRT和OT也有明显改善，显示出该平台增加手术活动的潜力。
