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目的:探讨机器人辅助腹腔镜肾部分切除术的学习曲线。方法:比较同一外科医生施行的早期20例机器人辅助腹腔镜肾部分切除术和最近20例腹腔镜肾部分切除术的围手术期结果。所有手术在2013年5月~2013年8月完成。既往该医生成功施行1 000余例腹腔镜肾部分切除术和300余例机器人辅助腹腔镜根治性前列腺切除术。比较2种术式的手术时间、热缺血时间、出血量、切缘阳性率、术后住院时间、围手术期并发症发生率。结果:2组患者术前临床资料和肿瘤病理学结果的比较差异无统计学意义(P>0.05)。2组均无切缘阳性病例。2组手术出血量、术后住院时间、围手术期并发症发生率差异无统计学意义(P>0.05)。在机器人辅助腹腔镜肾部分切除术的学习曲线中,手术时间和热缺血时间均呈下降趋势。经过早期9例手术后,机器人辅助腹腔镜肾部分切除术的平均手术时间即可接近最近20例腹腔镜肾部分切除术的平均手术时间。前9例机器人辅助腹腔镜肾部分切除术的平均手术时间是134min,热缺血时间是20min,远远长于后11例机器人辅助腹腔镜肾部分切除术平均手术时间107min,热缺血时间14min。结论:一个资深腹腔镜外科医生从腹腔镜肾部分切除术到机器人辅助腹腔镜肾部分切除术过渡是一个非常迅速的过程,经过前9例机器人辅助腹腔镜肾部分切除术后,行机器人辅助腹腔镜肾部分切除术和腹腔镜肾部分切除术的手术时间大致相同。2组热缺血时间、手术出血量、术后住院时间、手术出血量、术后住院时间、围手术期并发症发生率差异无统计学意义(P>0.05)。
Objective: To investigate the learning curve of robot-assisted laparoscopic partial nephrectomy. Methods: The perioperative results of 20 cases of robotic-assisted laparoscopic partial nephrectomy and the recent 20 cases of laparoscopic partial nephrectomy performed by the same surgeon were compared. All operations were completed in May 2013 ~ August 2013. In the past the doctor successfully implemented more than 1 000 cases of laparoscopic partial nephrectomy and more than 300 cases of robotic-assisted laparoscopic radical prostatectomy. The operation time, warm ischemia time, blood loss, positive margins, postoperative hospital stay and perioperative complications were compared between the two surgical procedures. Results: There was no significant difference in preoperative clinical data and tumor pathology between the two groups (P> 0.05). No case of positive margins in both groups. There was no significant difference in the amount of operative bleeding, postoperative hospital stay and perioperative complications (P> 0.05). In the robot-assisted laparoscopic partial nephrectomy learning curve, the operation time and warm ischemia time showed a downward trend. After the first nine cases of surgery, the mean operative time of robotic-assisted laparoscopic partial nephrectomy can approach that of the last 20 laparoscopic partial nephrectomies. The average operation time of the first nine cases of robot-assisted laparoscopic partial nephrectomy was 134 min, the warm ischemic time was 20 min, which was much longer than that of the latter 11 patients assisted by laparoscopic partial nephrectomy. The average operation time was 107 min and the warm ischemia time was 14 min. CONCLUSIONS: The transition from laparoscopic partial nephrectomy to robotic-assisted laparoscopic partial nephrectomy is a very rapid process by a senior laparoscopic surgeon. After the first nine cases of robotic-assisted laparoscopic partial nephrectomy, the robotic accessory abdominal cavity Partial nephrectomy and laparoscopic partial nephrectomy surgery time roughly the same. There was no significant difference in the incidence of warm ischemia, operation bleeding, postoperative hospital stay, operation bleeding, postoperative hospital stay, and perioperative complications (P> 0.05).