达芬奇机器人在食管癌根治术中学习曲线的研究

The learning curve of Da Vinci robotic surgical system for radical surgery in esophageal cancer

目的目前关于达芬奇机器人系统用于食管癌手术治疗的学习曲线研究较少。文中旨在评估达芬奇机器人手术系统在实施食管癌根治手术的临床效果,探讨胸外科医师达芬奇机器人手术系统学习曲线特征。方法回顾性分析2011年1月至2015年12月南京军区南京总医院心胸外科连续开展达芬奇机器人60例食管癌切除患者的临床资料。按手术开展时间的先后顺序分为A组(手术时间2011年1月至2013年1月)、B组(手术时间2013年2月至2014年2月)、C组(手术时间2014年3月至2015年12月),每组20例。比较各组机器人安装时间、胸腔腹腔游离时间、总手术时间及并发症等,分析机器人手术系统学习曲线。结果 60例患者手术均顺利完成,无中转开胸、开腹。3组并发症发病率差异无统计学意义(P>0.05)。随着手术例数的增加,A组、B组、C组总手术时间[(450.7±99.1)、(299.7±57.1)、(248.5±71.5)min]逐步缩短,差异有统计学意义(P<0.05)。经学习曲线分析结果显示,A组20例装机时间、胸腹腔游离时间及总手术时间明显长于B组、C组,在20例时拟合曲线出现转角,之后曲线开始渐缓。综合总手术时间、胸腹腔游离时间及装机时间可见机器人食管癌根治术学习曲线为20例。结论胸外科医师经过20例的学习,可掌握达芬奇机器人手术系统用于食管癌根治手术。

Objective At present,there are few studies about the learning curve of da Vinci robot system for surgical treatment of esophageal cancer.This study aimed to evaluate the surgical outcomes of Da Vinci robotic surgical system for radical surgery in esophageal cancer and explore the learning curve characteristics of thoracic surgeon. Methods Clinical data of 60 consecutive cases who received Da Vinci robot-assisted radical esophagectomy between January 2011 and December 2015 in Nanjing General Hospital were reviewed retrospectively.The cases were divided into 3 groups according to the operation period:group A(operation time:January 2011 to January 2013),group B(operation time:February 2013 to February 2014)and group C(operation time:March 2014 to December 2015).There were 20 cases in each group.The docking time,thoracic cavity anatomical separation time,total operation time and complication were compared.The learning curve of robotic surgery system were analyzed Results The operations of 60 patients were successfully completed without any transfer to thoracotomy or laparotomy.There was no statistically significant difference in the incidence of complications between the 3 groups(P>0.05).With the increase in the number of surgical cases,the total operation time of group A([450.7±99.1]min),group B([299.7±57.1]min)and group C([248.5±71.5]min)was gradually reduced.The difference was statistically significant(P<0.05).The robotic docking time,thoracic cavity anatomical separation time in group A was significantly longer than that in group B and C(P<0.05),and there was no significant difference between group B and group C(P>0.05).There were significant differences in total operation time among the three groups(P<0.05).After 20 cases,the fitting curve appeared turning angle,and then the curve began to slow down.Combined with the total operation time,pleural and abdominal cavity anatomical separation time and robotic docking time,it can be seen that the learning curve of Da Vinci robot-assisted radical robotic surgery in esophageal cancer was 20 cases. Conclusion After 20 cases of study,the thoracic surgeon can master the Da Vinci robotic surgical system for the radical surgery of esophageal cancer.