达芬奇机器人Xi系统肺段切除术的学习曲线

Learning curve of Da Vinci robot Xi system for lung segmentectomy

目的:研究第四代达芬奇机器人Xi系统在肺段切除术中的学习曲线。方法:回顾性分析武汉大学中南医院在2020年5月—2022年8月完成的第1~36例达芬奇机器人肺段切除术,采用CUSUM法拟合学习曲线,分析第四代达芬奇机器人肺段切除术中不同阶段的学习曲线,并通过文献检索与第三代机器人Si系统进行横向比较。结果:达芬奇机器人肺段切除术的CUSUM学习曲线的最佳拟合方程为CUSUM(n)=0.021×n^(3)-1.766×n^(2)+35.928×n+15.956(n为手术例数),拟合优度系数在R^(2)=0.809达到最大值(P<0.001),曲线在手术例数到第14例(n=14)时跨越了顶点,并以此为分界点将36例手术划分成两个阶段,即学习探索阶段(A组)和熟练掌握阶段(B组)。熟练掌握阶段(B组)的手术时间、术后引流量、淋巴结清扫数目、术后带管时间、术后住院时间、术后并发症差异相较于学习探索阶段(A组)更优,且有统计学意义(P<0.05)。相比于第三代达芬奇机器人Si手术系统,Xi系统学习曲线更短。结论:第四代达芬奇Xi机器人系统肺段切除术的学习曲线较短,只需要14例。比第三代Si系统在肺段切除手术方面更易于学习。

Objective:To study the learning curve of the fourth‐generation Da Vinci robot Xi system in lung segmentectomy.Methods:A retrospective analysis of the 1st to 36th cases of Da Vinci robot lung segmentectomy completed in Zhongnan Hospital of Wuhan University from May 2020 to August 2022 was carried out.The CUSUM method was used to fit the learning curve,and the learning curve of the fourth‐generation Da Vinci robot lung segmentectomy in different stages was analyzed and compared with the third‐generation robot Si system through the literature search.Results:The best fitting equation of the CUSUM learning curve of Da Vinci robotic segmentectomy is CUSUM(n)=0.021×n^(3)-1.766×n^(2)+35.928×n+15.956(n is the number of operation cases),the goodness of fit coefficient reached the maximum value at R^(2)=0.809(P<0.001),and the curve crossed the apex when the operation cases reached No.14(n=14).By the cut off value of 14,36 cases of operation were divided into two stages,namely,learning stage(group A)and mastery stage(group B).The differences of operation time,postoperative drainage volume,number of lymph node dissections,postoperative catheterization time,postoperative hospital stay,and postoperative complications in the mastery stage(group B)were superior to those in the learning stage(group A)(P<0.05).Conclusion:The learning curve of lung segmentectomy with the fourth generation Da Vinci Xi robot system is short,and only 14 cases are needed.It is easier to learn than the third generation Si system in segmentectomy surgery.