Zhang Jianlu, Li Pengyu, Zhang Pan, Wang Yajun, Guo Junchao
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing street, Dongcheng District, Beijing, 100730, China.
J Robot Surg. 2025 Jul 12;19(1):381. doi: 10.1007/s11701-025-02574-0.
Robot-assisted pancreatic surgery (RPS) is increasingly adopted across institutions. While structured training and longitudinal skill acquisition are essential for optimal outcomes, the learning progression of surgical assistants in RPS remains inadequately characterized. This study presents our institution's standard operating procedures (SOP) for robot-assisted distal pancreatectomy (RDP) developed through a single-team cohort experience and defines the assistant learning curve based on operative time, thereby establishing evidence-based benchmarks for RPS training programs. In this retrospective study, data of consecutive patients who underwent RDP in our team from November 2022 to March 2025 were analyzed. The assistant learning curve was constructed using cumulative sum (CUSUM) analysis of operative time. The preoperative parameters, intraoperative outcomes, and postoperative metrics were compared between phases. Ninety-one patients were included in this study. Based on operative time analysis, the learning curve was stratified into two distinct phases: the initial learning phase (cases 1-43) and subsequent proficiency phase (cases 44-91). Operative duration and estimated blood loss were significantly greater during the learning phase compared to the proficiency phase. Among patients scheduled for spleen-preserving RDP, while overall spleen preservation rates were comparable between phases, proficiency phase cases demonstrated significantly superior splenic vessel preservation rates. Our RDP-specific SOP demonstrates safety and efficacy, with assistant proficiency significantly improving after 43 cases under expert supervision. Quantified learning thresholds provide validated benchmarks for structured robotic surgery training programs.
机器人辅助胰腺手术（RPS）在各医疗机构中的应用日益广泛。虽然结构化培训和长期技能获取对于实现最佳手术效果至关重要，但RPS中手术助手的学习进程仍未得到充分描述。本研究介绍了我们机构通过单团队队列经验制定的机器人辅助远端胰腺切除术（RDP）的标准操作流程（SOP），并根据手术时间定义了助手的学习曲线，从而为RPS培训项目建立基于证据的基准。在这项回顾性研究中，分析了2022年11月至2025年3月在我们团队接受RDP的连续患者的数据。使用手术时间的累积和（CUSUM）分析构建助手学习曲线。比较各阶段的术前参数、术中结果和术后指标。本研究纳入了91例患者。根据手术时间分析，学习曲线分为两个不同阶段：初始学习阶段（病例1 - 43）和随后的熟练阶段（病例44 - 91）。与熟练阶段相比，学习阶段的手术持续时间和估计失血量明显更大。在计划进行保留脾脏的RDP的患者中，虽然各阶段的总体脾脏保留率相当，但熟练阶段的病例脾脏血管保留率明显更高。我们特定于RDP的SOP显示出安全性和有效性，在专家监督下完成43例手术后，助手的熟练程度显著提高。量化的学习阈值为结构化机器人手术培训项目提供了经过验证的基准。
