Abstract: Learning curve of Da Vinci robot-assisted laparoscopic radical resection for rectal cancer        QIN Qian, ZHANG Lei, SHI Fei-yu et al. Department of General Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
Corresponding author: SHE Jun-jun, E-mail: junjunshe1975@sina.com
Abstract    Objective    To investigate the learning curve of Da Vinci robot-assisted laparoscopic radical resection for rectal cancer. Methods    The retrospective cohort study was conducted. The clinicopathologic data of 53 patients of Da Vinci robot-assisted laparoscopic radical resection for rectal cancer performed by the same group of physicians in Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University from November 2017 to May 2019 were prospectively collected. The learning curve was evaluated by the multi-factor cumulative sum (CUSUM) analysis and the best fitting curve method. The comparison of the general data and short-term clinical outcomes of patients in different learning stages verified the learning curve and explored the impact of different learning stages on the clinical efficacy of patients. Results    The best fitting equation of the learning curve reached the peak at the time of the 23rd case, and 23 cases were the minimum number of cases that surgeons needed to cross the learning curve. According to the learning curve, it was divided into the learning improvement stage and the proficiency stage. Only the difference in the operation time was statistically significant (P<0.05), while the differences in intraoperative blood loss, the number of lymph nodes detected, the time of first feeding, postoperative complications and postoperative hospitalization time were not statistically significant (P>0.05). Conclusion    The learning curve of Da Vinci robot-assisted radical resection for rectal cancer can be divided into two stages: the learning improvement stage and the proficiency stage. The surgeons may need to finish at least 23 cases to master Da Vinci robot-assisted laparoscopic radical resection for rectal cancer.

Key words: CUSUM analysis, best fitting curve, learning curve, Da Vinci robot, ractal cancer

摘要： 目的    探讨达芬奇机器人手术系统辅助直肠癌根治术的学习曲线。方法    采用回顾性队列研究方法，分析西安交通大学第一附属医院普通外科同一组医师2017-10-01至2019-06-30连续开展的53例达芬奇机器人手术系统辅助直肠癌根治术病人的临床资料，采用多因素累积和（CUSUM）分析法及最佳拟合曲线分析该手术的学习曲线，通过对比各学习阶段病人的一般资料及短期临床结局验证学习曲线，并探究不同学习阶段对于病人临床疗效的影响。结果    学习曲线的最佳拟合方程在第23例时达到峰值，23例为跨越学习曲线所需要累积的最少手术例数，依据学习曲线图将其分为学习提高阶段和熟练掌握阶段。2个阶段病人仅手术时间差异有统计学意义（P＜0.05），术中出血量、淋巴结检出数目、术后首次排气时间、术后并发症、术后住院时间差异均无统计学意义（P＞0.05）。结论    达芬奇机器人手术系统辅助直肠癌根治术学习曲线可分为学习提高、熟练掌握2个阶段；23例可能为跨越学习曲线所需要累积的最少手术例数。

关键词: 累积和分析法, 最佳拟合曲线, 学习曲线, 达芬奇机器人, 直肠癌