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机器人辅助结肠切除术的学习曲线:手术熟练度、手术结果及培训方案的系统评价与荟萃分析

Learning curve of robotic colectomy: a systematic review and meta-analysis of surgical proficiency, outcomes, and training protocols.

作者信息

Coco Danilo, Leanza Silvana

机构信息

Department of General, Robotic and Oncologic Surgery, Giglio Foundation Hospital Cefalu', Palermo, Italy.

出版信息

J Robot Surg. 2025 Aug 25;19(1):509. doi: 10.1007/s11701-025-02648-z.

Abstract

UNLABELLED

This investigation systematically evaluates the skill acquisition process in robotic colectomy procedures, determining the case volume required for surgical competency and assessing the effectiveness of various training methodologies. A comprehensive evidence synthesis was performed according to PRISMA standards. Multiple medical databases (PubMed, Embase, Cochrane Library) were systematically interrogated for relevant publications from January 2000 to January 2024. Eligible studies documented proficiency development in robotic colectomy, providing metrics on procedure duration, adverse events, and educational approaches. Analytical methods incorporated random-effects modeling with heterogeneity evaluation through I indices.

METHODS

From an initial pool of 1,800 potential studies, 35 met rigorous inclusion criteria, collectively representing 7500 surgical cases.

RESULTS

Proficiency development required between 20 and 70 procedures, with a weighted mean of 45 cases (95% confidence interval: 40-50). Significant reductions in operative duration (p < 0.001) and complication frequency (25% to 10%, p = 0.005) were observed following competency attainment. Training methodologies demonstrated considerable variation, with case volume requirements (designated TR-100 to TR-500) showing differential effectiveness. Formalized instructional programs incorporating simulation training and expert supervision correlated with accelerated skill acquisition.

CONCLUSION

achieving technical proficiency in robotic colectomy typically necessitates approximately 45 cases, with measurable enhancements in both procedural efficiency and clinical outcomes. The implementation of systematic training frameworks, particularly those integrating simulation components and mentored practice, appears crucial for optimizing surgical education.

摘要

未标注

本研究系统评估了机器人结肠切除术的技能习得过程,确定了达到手术能力所需的病例数量,并评估了各种培训方法的有效性。根据PRISMA标准进行了全面的证据综合分析。系统检索了多个医学数据库(PubMed、Embase、Cochrane图书馆),以查找2000年1月至2024年1月期间的相关出版物。符合条件的研究记录了机器人结肠切除术中熟练程度的发展情况,提供了手术时长、不良事件和教育方法等指标。分析方法采用随机效应模型,并通过I指数进行异质性评估。

方法

从最初的1800项潜在研究中,有35项符合严格的纳入标准,共代表7500例手术病例。

结果

熟练程度的发展需要进行20至70例手术,加权平均为45例(95%置信区间:40 - 50)。达到能力水平后,手术时长(p < 0.001)和并发症发生率(从25%降至10%,p = 0.005)有显著降低。培训方法差异很大,病例数量要求(指定为TR - 100至TR - 500)显示出不同的效果。结合模拟训练和专家监督的正规教学计划与技能获取加速相关。

结论

在机器人结肠切除术中达到技术熟练通常需要约45例手术,手术效率和临床结果均有可衡量的提高。实施系统的培训框架,特别是那些整合模拟组件和带教实践的框架,对于优化外科教育似乎至关重要。

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