期刊
ANNALS OF SURGERY
卷 273, 期 5, 页码 949-956出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000003583
关键词
complication; learning curve; operation time; robotic gastrectomy; robotic surgery
类别
资金
- National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea [1020410]
- Korea University Grant
This study evaluates the learning curve and associated complications of robotic gastrectomy, showing that complications decrease as surgeons gain experience. Intra-abdominal bleeding and abdominal pain are major learning-associated morbidities, with prior laparoscopic experience and training methods influencing the curve. Robotic gastrectomy is a complex procedure with a significant learning curve, highlighting the importance of training and credentialing for physicians.
Objective: To evaluate the complication-based learning curve and identify learning-associated complications of robotic gastrectomy. Summary Background Data: With the increased popularity of robotic surgery, a sound understanding of the learning curve in the surgical outcome of robotic surgery has taken on great importance. However, a multicenter prospective study analyzing learning-associated morbidity has never been conducted in robotic gastrectomy. Methods: Data on 502 robotic gastrectomy cases were prospectively collected from 5 surgeons. Risk-adjusted cumulative sum analysis was applied to visualize the learning curve of robotic gastrectomy on operation time and complications. Results: Twenty-five cases, on average, were needed to overcome complications and operation time-learning curve sufficiently to gain proficiency in 3 surgeons. An additional 23 cases were needed to cross the transitional phase to progress from proficiency to mastery. The moderate complication rate (CD >= grade II) was 20% in phase 1 (cases 1-25), 10% in phase 2 (cases 26-65), 26.1% in phase 3 (cases 66-88), and 6.4% in phase 4 (cases 89-125) (P < 0.001). Among diverse complications, CD >= grade II intra-abdominal bleeding (P < 0.001) and abdominal pain (P = 0.01) were identified as major learning-associated morbidities of robotic gastrectomy. Previous experience on laparoscopic surgery and mode of training influenced progression in the learning curve. Conclusions: This is the first study suggesting that technical immaturity substantially affects the surgical outcomes of robotic gastrectomy and that robotic gastrectomy is a complex procedure with a significant learning curve that has implications for physician training and credentialing.
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