Inamoto Susumu, Nomura Akinari, Tsukasaki Shota, Okada Tomoaki, Kanaya Seiichiro, Sakai Yoshiharu
Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70103. doi: 10.1111/ases.70103.
Robotic surgery has gained worldwide popularity due to its versatility and clinical benefits. However, issues associated with high costs, safety, specialized training requirements, and trainee education remain. Despite several preclinical training strategies, it is necessary to train while performing surgery in order to improve surgical technique. Since most institutions lack dual-console systems, alternative training strategies must be developed.
To enhance surgical training, a real-time annotation tool and hybrid surgery-where assistant surgeons actively utilize laparoscopic instruments-was implemented in trainee-performed colectomies. Short-term clinical outcomes were compared between robotic colectomies performed by proctors and those performed by trainees. Robotic colectomy learning curves were assessed using cumulative sum (CUSUM) analysis.
Between August 2021 and October 2024, 58 and 52 robotic colectomies were performed by proctors and trainee surgeons, respectively. Although no significant differences were observed in patient characteristics or clinical outcomes, operative time (265 vs. 343 min, p < 0.05) and console time (184 vs. 263.5 min, p < 0.05) were significantly longer in the trainee group. CUSUM analysis indicated that proctors required 16 cases to reach the learning phase and 33 cases to achieve mastery. The trainee learning curve displayed a short bimodal pattern, which was distinctly separated in April 2024, corresponding to between-batch transition. This suggests that the real-time annotation tool and hybrid surgery effectively maintained surgical quality.
The combination of a real-time annotation tool and hybrid surgery represents a safe and effective training strategy for trainee surgeons performing robotic colectomy in a single-console institution.
机器人手术因其多功能性和临床益处而在全球范围内受到欢迎。然而，与高成本、安全性、专业培训要求和学员教育相关的问题仍然存在。尽管有几种临床前培训策略，但为了提高手术技术，在进行手术时进行培训是必要的。由于大多数机构缺乏双控制台系统，必须制定替代培训策略。
为了加强手术培训，在学员进行的结肠切除术中实施了实时注释工具和混合手术（即助理外科医生积极使用腹腔镜器械）。比较了由带教老师进行的机器人结肠切除术和学员进行的机器人结肠切除术的短期临床结果。使用累积和（CUSUM）分析评估机器人结肠切除术的学习曲线。
在2021年8月至2024年10月期间，带教老师和学员外科医生分别进行了58例和52例机器人结肠切除术。虽然在患者特征或临床结果方面未观察到显著差异，但学员组的手术时间（265对343分钟，p<0.05）和控制台操作时间（184对263.5分钟，p<0.05）明显更长。CUSUM分析表明，带教老师需要16例手术才能进入学习阶段，33例手术才能达到熟练掌握。学员的学习曲线呈现出短双峰模式，在2024年4月明显分开，对应批次间的过渡。这表明实时注释工具和混合手术有效地维持了手术质量。
实时注释工具和混合手术的结合是在单控制台机构中为进行机器人结肠切除术的学员外科医生提供的一种安全有效的培训策略。
