机器人辅助腹腔镜肾部分切除术的学习曲线

Learning curve for robot-assisted laparoscopic partial nephrectomy

目的：探讨机器人辅助腹腔镜肾部分切除术的学习曲线.方法：比较同一外科医生施行的早期20例机器人辅助腹腔镜肾部分切除术和最近20例腹腔镜肾部分切除术的围手术期结果.所有手术在2013年5月~2013年8月完成.既往该医生成功施行1000余例腹腔镜肾部分切除术和300余例机器人辅助腹腔镜根治性前列腺切除术.比较2种术式的手术时间、热缺血时间、出血量、切缘阳性率、术后住院时间、围手术期并发症发生率.结果：2组患者术前临床资料和肿瘤病理学结果的比较差异无统计学意义(P ＞0.05).2组均无切缘阳性病例.2组手术出血量、术后住院时间、围手术期并发症发生率差异无统计学意义(P ＞0.05).在机器人辅助腹腔镜肾部分切除术的学习曲线中，手术时间和热缺血时间均呈下降趋势.经过早期9例手术后，机器人辅助腹腔镜肾部分切除术的平均手术时间即可接近最近20例腹腔镜肾部分切除术的平均手术时间.前9例机器人辅助腹腔镜肾部分切除术的平均手术时间是134 mi n ，热缺血时间是20 mi n ，远远长于后11例机器人辅助腹腔镜肾部分切除术平均手术时间107 mi n ，热缺血时间14 mi n .结论：一个资深腹腔镜外科医生从腹腔镜肾部分切除术到机器人辅助腹腔镜肾部分切除术过渡是一个非常迅速的过程，经过前9例机器人辅助腹腔镜肾部分切除术后，行机器人辅助腹腔镜肾部分切除术和腹腔镜肾部分切除术的手术时间大致相同.2组热缺血时间、手术出血量、术后住院时间、手术出血量、术后住院时间、围手术期并发症发生率差异无统计学意义(P ＞0.05).

To discuss the learni ng curve of Robot-assisted laparoscopic partial nephrecto my (PALPN).Meth-ods :We compared the perioperative outcomes of the first 20 patients who under went RALPN to the latest 20 patients who under went LPN performed by the same surgeons .All surgical operations ere done Bet ween May 2013 and August 2013 .The surgeons had completed more than 1000cases of LPN and more than 300 cases of robot-assisted laparoscopic radical prosta-tecto my .The learning curve was defined as the number of cases required to proficiently perform RALNP with shorter aver-age operative time (OT)and war mische miatimes (WIT),as co mpared to the latest 20 patients subject to LPN.Results :The two groups had comparable preoperative de mographics and tumor histopathology .No patients in either group had a pos-itive surgical margin .There was a do wnward trend in both OT and WIT during the RALPNlearning curve .After RALPN for the first 9 cases ,the average OT reached that of the last 20 cases subject to LPN.The average OT and WIT of the first 9 cases subject to RALPN werepatients 134 min and 20 min ,compared with those of 107 min and 14 min of the last 11 cases subject to RALPN.Conclusions :The transition from LPNto RALNP is rapid in an experienced laparoscopic surgeon .There were no significant differences in WIT,blood loss ,or length of hospital stay bet ween LPN and RALPN.RALPN achieved a similar OT as LPN after 9 procedures .