Wu Buwei, Yang Chunsen, Zhao Hongcheng, Ma Tianhao, Yao Xin, Liao Wenfeng
Department of Urologic Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
J Robot Surg. 2025 Aug 14;19(1):483. doi: 10.1007/s11701-025-02610-z.
Robot-assisted laparoscopic partial nephrectomy (RALPN) has increasingly emerged as a primary minimally invasive surgical approach for managing renal masses. In China, most urologic surgeons lack experience in transperitoneal laparoscopic partial nephrectomy, and limited research exists on the learning curve for transperitoneal RALPN. This study applies cumulative sum (CUSUM) analysis to evaluate the learning curve, providing clinical suggestions. We recruited patients who underwent transperitoneal RALPN performed by a single surgeon between March 2017 and December 2023. The learning curve was evaluated using CUSUM analysis of operative time (OT). The curve's peak was used as the cutoff point to stratify patients for comparative analysis of clinical characteristics and perioperative outcomes. In addition, multivariate linear regression analysis was used to identify potential factors influencing OT. 119 patients were enrolled. The curve peaked at the 38th case and subsequently declined, dividing the patients into two groups: the learning phase (38 cases) and the mastery phase (81 cases). OT (115 vs. 150 min., P < 0.001), WIT (19 vs. 24 min., P < 0.001), and hospital stay (6 vs. 7 days, P = 0.005) were lower in the mastery phase. Tumor size (P = 0.027) and surgeon experience (P < 0.001) were identified as potential risk factors for OT. This study demonstrates that the learning curve for transperitoneal RALPN is relatively short. Comparative analysis of perioperative outcomes revealed superior outcomes during the mastery phase. These findings may serve as a benchmark for urologic surgeons' skill acquisition.
机器人辅助腹腔镜肾部分切除术（RALPN）已日益成为治疗肾肿块的主要微创外科手术方法。在中国，大多数泌尿外科医生缺乏经腹腹腔镜肾部分切除术的经验，关于经腹RALPN学习曲线的研究有限。本研究应用累积和（CUSUM）分析来评估学习曲线，并提供临床建议。我们招募了在2017年3月至2023年12月期间由单一外科医生进行经腹RALPN的患者。使用手术时间（OT）的CUSUM分析来评估学习曲线。以曲线峰值作为分界点对患者进行分层，以比较分析临床特征和围手术期结局。此外，采用多变量线性回归分析来确定影响OT的潜在因素。共纳入119例患者。曲线在第38例时达到峰值，随后下降，将患者分为两组：学习阶段（38例）和熟练阶段（81例）。熟练阶段的OT（115 vs. 150分钟，P < 0.001）、热缺血时间（WIT，19 vs. 24分钟，P < 0.001）和住院时间（6 vs. 7天，P = 0.005）较低。肿瘤大小（P = 0.027）和外科医生经验（P < 0.001）被确定为OT的潜在风险因素。本研究表明，经腹RALPN的学习曲线相对较短。围手术期结局的比较分析显示熟练阶段的结局更佳。这些发现可为泌尿外科医生技能的获得提供一个基准。
