{"title":"腹腔外单部位机器人辅助根治性前列腺切除术的学习曲线分析:基于cusum的方法。","authors":"Jianhao Wu, Yubo Wang, Yueting Huang, Xuezhi Long, Jiahui Tang, Di Gu","doi":"10.1007/s11701-024-02202-3","DOIUrl":null,"url":null,"abstract":"<p><p>This study applied cumulative sum (CUSUM) analysis to evaluate trends in operative time and blood loss, It aims to identify key milestones in mastering extraperitoneal single-site robotic-assisted radical prostatectomy (ss-RARP). A cohort of 100 patients who underwent ss-RARP, performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023, was retrospectively analyzed. To evaluate the learning curve, the CUSUM (Cumulative Sum Control Chart) technique was applied, revealing the progression and variability over time. A cubic polynomial model was utilised to fit the non-linear data trends accurately. Key perioperative outcomes, such as operative duration and estimated blood loss, were assessed and compared between distinct learning stages to identify improvements and transitions during the surgeon's proficiency development. A total of 100 patients were included, with a mean age of 71.44 ± 5.46 years. The median operative time was 119.53 min (94, 144), and the best-fit equation for the CUSUM learning curve of operative time was y = 387.0373 - 3.4334x - 0.2982x<sup>2</sup> + 0.003x<sup>3</sup> (R<sup>2</sup> = 0.898), reaching its peak at the 11th case. The median blood loss was 49.9 ml (20, 50), and the best-fit equation for the CUSUM learning curve of blood loss was y = 444.9362 + 23.6787x - 0.7719x<sup>2</sup> + 0.0049x<sup>3</sup> (R<sup>2</sup> = 0.957), reaching its peak at the 27th case. The learning curve was divided into a learning phase (1-27 cases) and a proficient phase (28 cases onward). Intraoperative blood loss significantly decreased from 75.93 ± 79.19 mL to 40.27 ± 35.27 mL in the proficient phase (P < 0.05), while operative time remained similar between phases (P > 0.05).There were no statistically significant differences in pelvic drainage tube placement time, drainage volume, positive surgical margin rate, hospital stay duration, or postoperative pain scores (P > 0.05). The findings suggest that proficiency in ss-RARP is typically achieved after approximately 27 cases, indicating a manageable and safe learning curve. These insights can inform the design of surgical training programmes, optimising early learning and improving clinical outcomes for novice surgeons.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"49"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723840/pdf/","citationCount":"0","resultStr":"{\"title\":\"Learning curve analysis of extraperitoneal single-site robotic-assisted radical prostatectomy: a CUSUM-based approach.\",\"authors\":\"Jianhao Wu, Yubo Wang, Yueting Huang, Xuezhi Long, Jiahui Tang, Di Gu\",\"doi\":\"10.1007/s11701-024-02202-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This study applied cumulative sum (CUSUM) analysis to evaluate trends in operative time and blood loss, It aims to identify key milestones in mastering extraperitoneal single-site robotic-assisted radical prostatectomy (ss-RARP). A cohort of 100 patients who underwent ss-RARP, performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023, was retrospectively analyzed. To evaluate the learning curve, the CUSUM (Cumulative Sum Control Chart) technique was applied, revealing the progression and variability over time. A cubic polynomial model was utilised to fit the non-linear data trends accurately. Key perioperative outcomes, such as operative duration and estimated blood loss, were assessed and compared between distinct learning stages to identify improvements and transitions during the surgeon's proficiency development. A total of 100 patients were included, with a mean age of 71.44 ± 5.46 years. The median operative time was 119.53 min (94, 144), and the best-fit equation for the CUSUM learning curve of operative time was y = 387.0373 - 3.4334x - 0.2982x<sup>2</sup> + 0.003x<sup>3</sup> (R<sup>2</sup> = 0.898), reaching its peak at the 11th case. The median blood loss was 49.9 ml (20, 50), and the best-fit equation for the CUSUM learning curve of blood loss was y = 444.9362 + 23.6787x - 0.7719x<sup>2</sup> + 0.0049x<sup>3</sup> (R<sup>2</sup> = 0.957), reaching its peak at the 27th case. The learning curve was divided into a learning phase (1-27 cases) and a proficient phase (28 cases onward). Intraoperative blood loss significantly decreased from 75.93 ± 79.19 mL to 40.27 ± 35.27 mL in the proficient phase (P < 0.05), while operative time remained similar between phases (P > 0.05).There were no statistically significant differences in pelvic drainage tube placement time, drainage volume, positive surgical margin rate, hospital stay duration, or postoperative pain scores (P > 0.05). The findings suggest that proficiency in ss-RARP is typically achieved after approximately 27 cases, indicating a manageable and safe learning curve. These insights can inform the design of surgical training programmes, optimising early learning and improving clinical outcomes for novice surgeons.</p>\",\"PeriodicalId\":47616,\"journal\":{\"name\":\"Journal of Robotic Surgery\",\"volume\":\"19 1\",\"pages\":\"49\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723840/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Robotic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11701-024-02202-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Robotic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11701-024-02202-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Learning curve analysis of extraperitoneal single-site robotic-assisted radical prostatectomy: a CUSUM-based approach.
This study applied cumulative sum (CUSUM) analysis to evaluate trends in operative time and blood loss, It aims to identify key milestones in mastering extraperitoneal single-site robotic-assisted radical prostatectomy (ss-RARP). A cohort of 100 patients who underwent ss-RARP, performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023, was retrospectively analyzed. To evaluate the learning curve, the CUSUM (Cumulative Sum Control Chart) technique was applied, revealing the progression and variability over time. A cubic polynomial model was utilised to fit the non-linear data trends accurately. Key perioperative outcomes, such as operative duration and estimated blood loss, were assessed and compared between distinct learning stages to identify improvements and transitions during the surgeon's proficiency development. A total of 100 patients were included, with a mean age of 71.44 ± 5.46 years. The median operative time was 119.53 min (94, 144), and the best-fit equation for the CUSUM learning curve of operative time was y = 387.0373 - 3.4334x - 0.2982x2 + 0.003x3 (R2 = 0.898), reaching its peak at the 11th case. The median blood loss was 49.9 ml (20, 50), and the best-fit equation for the CUSUM learning curve of blood loss was y = 444.9362 + 23.6787x - 0.7719x2 + 0.0049x3 (R2 = 0.957), reaching its peak at the 27th case. The learning curve was divided into a learning phase (1-27 cases) and a proficient phase (28 cases onward). Intraoperative blood loss significantly decreased from 75.93 ± 79.19 mL to 40.27 ± 35.27 mL in the proficient phase (P < 0.05), while operative time remained similar between phases (P > 0.05).There were no statistically significant differences in pelvic drainage tube placement time, drainage volume, positive surgical margin rate, hospital stay duration, or postoperative pain scores (P > 0.05). The findings suggest that proficiency in ss-RARP is typically achieved after approximately 27 cases, indicating a manageable and safe learning curve. These insights can inform the design of surgical training programmes, optimising early learning and improving clinical outcomes for novice surgeons.
期刊介绍:
The aim of the Journal of Robotic Surgery is to become the leading worldwide journal for publication of articles related to robotic surgery, encompassing surgical simulation and integrated imaging techniques. The journal provides a centralized, focused resource for physicians wishing to publish their experience or those wishing to avail themselves of the most up-to-date findings.The journal reports on advance in a wide range of surgical specialties including adult and pediatric urology, general surgery, cardiac surgery, gynecology, ENT, orthopedics and neurosurgery.The use of robotics in surgery is broad-based and will undoubtedly expand over the next decade as new technical innovations and techniques increase the applicability of its use. The journal intends to capture this trend as it develops.