达芬奇单端口机器人系统胆囊切除术的学习曲线。

IF 1.2 4区 医学 Q3 SURGERY
Niccolò Ramacciotti, Francesco Celotto, Federico Pinto, Jessica Cassiani, Giacomo Danieli, Gaya Spolverato, Luca Morelli, Francesco Maria Bianco
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引用次数: 0

摘要

背景:微创手术被认为是胆囊切除术的金标准,随着时间的推移,各种方法已经被实施。自2018年以来,达芬奇单端口(DVSP)机器人系统(Intuitive)已用于实验手术环境,重新激发了对单部位手术技术的兴趣。作者的目的是描述与单孔机器人胆囊切除术(SPRC)相关的学习曲线。方法:对一名具有腹腔镜、单部位手术和多端口机器人手术经验的外科医生连续进行的266例超说明书SPRC进行前瞻性分析。这些程序是根据机构审查委员会批准的程序进行的。收集并整理术前、术中、术后资料。SPRC的适应症包括症状性胆结石、急性胆囊炎、慢性胆囊炎、瓷胆囊、胆囊息肉、胆总管结石、胆石性胰腺炎。使用累积和分析(CUSUM)生成学习曲线,以评估总体手术时间、对接时间、控制台前时间和外科医生控制台时间的变化。结论:SPRC是一种安全可行的手术,手术对接时间、手术前时间和总时间随时间的推移而改善,同时手术前时间在整个病例序列中保持稳定,表明其他微创入路和DVSP平台之间有显著的能力转移。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Learning Curve for da Vinci Single-Port Robotic System Cholecystectomy.

Background: Minimally invasive surgery is recognized as the gold standard for cholecystectomy, with various approaches having been implemented over time. Since 2018, the da Vinci Single-Port (DVSP) robotic system (Intuitive) has been used in experimental surgical contexts, revitalizing interest in single-site surgical techniques. The authors' aim is to describe the learning curve associated with single-port robotic cholecystectomy (SPRC).

Methods: A prospective series of 266 consecutive off-label SPRC performed by a single surgeon experienced in laparoscopy, single-site surgery, and multiport robotic surgery was analyzed. These procedures were conducted under an Institutional Review Board-approved protocol. Preoperative, intraoperative, and postoperative data were collected and organized. Indications for SPRC included symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, porcelain gallbladder, gallbladder polyps, choledocholithiasis, and gallstone pancreatitis. A learning curve was generated using the cumulative sum analysis (CUSUM) to assess changes in overall operation time, docking time, pre-console time, and surgeon console time.

Results: Our analysis demonstrated a statistically significant reduction in docking time and pre-console time (P<0.001) in the 3 phases identified by the CUSUM analysis. The CUSUM analysis identified only 1 phase regarding the console time with a mean time of 20 (7 to 113) minutes. The average overall time was 59 (19 to 175) minutes. CUSUM analysis identified 3 phases for overall time, with reduction from 59 to 46 minutes (P<0.001). The general characteristics of the groups identified for OT were homogeneous. Analysis of early surgical outcomes did not differ between the groups.

Conclusions: SPRC is a safe and feasible procedure, the docking time, pre-console time, and overall time were improving over time, meanwhile the console time was stable throughout the case series demonstrating a significant ability transfer between other mininvasive approaches and DVSP Platform.

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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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