单一术者经脐单孔腹腔镜肾上腺切除术学习曲线分析

Analysis of the learning curve of transumbilical laparoendoscopic single-site adrenalectomy by a single surgeon

目的评估单一术者在不同阶段操作的经脐单孔腹腔镜肾上腺切除术(LESS-A)之手术效果,探讨该术式的学习曲线。方法回顾性分析南京中医药大学附属医院由同一术者在2015年3月至2019年12月连续完成的87例经脐单孔腹腔镜肾上腺切除术的临床资料。按时间顺序将患者分为4组(第一阶段组第1~21例,第二阶段组第22~42例,第三阶段组第43~63例,第四阶段组第64~87例),比较4组的手术时间、术中出血、引流管留置时间、术后住院天数等方面的差异。结果随术者经验例数的累积,手术时间、术中出血、引流管留置时间、术后住院天数均呈下降趋势。第一阶段组与第二阶段组间在除术中出血外的围术期资料差异均有统计学意义(P<0.05),第二阶段组与第三阶段组仅术中出血量的差异存在统计学意义(P<0.05)。第三阶段组与第四阶段组研究的各项围术期资料差异均无统计学意义(P均>0.05)。结论经脐单孔腹腔镜肾上腺切除术(LESS-A)学习曲线相对陡峭。单一术者达到40~45例手术的经验积累后可基本掌握,完成50例手术后熟练和稳定程度明显提高。

Objective To evaluate the surgical efficacy of transumbilical laparoendoscopic single-site adrenalectomy(LESS-A)in different stages,and to assess the learning curve.Methods The clinical data of 87 patients who underwent transumbilical LESS-A by the same surgeon during Mar.2015 and Dec.2019 were retrospectively analyzed.The patients were divided into 4 groups according to the time sequence:first-stage group(patients 1 to 21),second-stage group(patients 22 to 42),third-stage group(patients 43 to 63),and fourth-stage group(patients 64 to 87).The operation time,intraoperative blood loss,drainage tube indwelling time and postoperative hospital stay were compared among the 4 groups.Results With the increase of the number of cases,the operation time,blood loss,drainage tube indwelling time and hospital stay all decreased(all P<0.05).Except blood loss,there were statistical differences in the parameters between first-stage and second-stage groups(all P<0.05),and in blood loss between second-stage and third-stage groups(P<0.05),while there were no differences in the parameters between third-stage and fourth-stage groups(all P>0.05).Conclusion Transumbilical LESS-A is safe and feasible,and the learning curve is relatively steep.The surgeons can basically command the procedures after 40 to 45 surgeries and improve proficiency and stability after 50 surgeries.