The learning curve of da Vinci robot-assisted pulmonary lobectomy by using cumulative sum analysis

doi:10.3877/cma.j.issn.1674-6899.2018.04.008

Abstract

Abstract:

Objective

This study aims to investigate the learning curve of da Vinci robot-assisted pulmonary lobectomy.

Methods

A cumulative sum analysis (CUSUM) was performed on the operation time (OT) of the 1st to the 109^th patients who underwent da Vinci robot-assisted pulmonary lobectomy from Mar. 2012 to Feb. 2015 in our hospital. A multivariate linear regression was performed, in order to exclude the bias factors on OT. The CUSUM learning curve was modeled by curve fitting and R² was used to testify the goodness. The different phases of the learing curve was compared on OT, estimated blood loss (EBL), lymph nodes dissecting, complications, drainage time and hospital stay.

Results

The OT decreased with the accumulation of cases. The CUSUM learning curve was best modeled as a cubic curve with the equation: CUSUM(n)=0.002×n³-0.323×n²+ 13.360×n-18.195, which had a higher R² value of 0.847. The fitting curve reached the top at the 28^th case. As a cut-off point, the 28^th case di Vided the learning curve into two phases. There were statistical differences in OT (P=0.022), EBL (P=0.014), numbers of lymph nodes dissected (P=0.022), complications (P=0.015), drainage time (P=0.025) and hospital stay (P=0.005).

Conclusions

The learning curve of da Vinci robot-assisted pulmonary lobectomy can be defined by CUSUM analysis, which suggested from our data that the surgeons need finish about 28 cases to master the technique.

Key words: Robot-assisted pulmonary lobectomy, CUSUM analysis, Learning curve, Multivariate linear regression

Xiangmin Lai, Bo Liu, Can Sun, Daqiang Xu, Yanpeng Shi, Boxiao Hu, Xingchi Liu, Shiguang Xu, Shumin Wang. The learning curve of da Vinci robot-assisted pulmonary lobectomy by using cumulative sum analysis[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(04): 220-223.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2018.04.008

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2018/V11/I04/220

Figures/Tables 2

References 18

1	王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望[J]. 中国肿瘤， 2014, 23(9):736-742.
2	Veronesi G. Robotic surgery for the treatment of early-stage lung cancer[J]. Current Opinion in Oncology, 2013, 25(2):107-114.
3	Toker A. Robotic thoracic surgery: from the perspectives of european chest surgeons[J]. Journal of Thoracic Disease, 2014, 6(2):211-216.
4	Ricciardi S, Cardillo G, Zirafa CC, et al. Robotic lobectomies: when and why[J]. Journal of Visualized Surgery, 2017, 3(112):1-7.
5	Yamashita S, Yoshida Y, Iwasaki A. Robotic surgery for thoracic disease[J]. Annals of Thoracic & Cardiovascular Surgery Official Journal of the Association of Thoracic & Cardiovascular Surgeons of Asia, 2016, 22(1):1-5.
6	李欣，侯纯升，白洋，等. 单孔腹腔镜胆囊切除术的学习曲线：累积求和分析法[J]. 中国微创外科杂志， 2016, 16(3):241-244.
7	Khan N, Abboudi H, Khan MS, et al. Measuring the surgical "learning curve" ： methods, variables and competency[J]. Bju International, 2014, 113(3):504-508.
8	Bokhari MB, Patel CB. Learning curve for robotic-assisted laparoscopic colorectal surgery[J]. Surgical Endoscopy, 2011, 25(3):855-860.
9	Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach[J]. Artificial Organs, 2014, 38(5):431-433.
10	宋德胜，于在诚，胡旭，等. 单向式全胸腔镜肺癌根治术探讨[J/CD]. 中华腔镜外科杂志(电子版), 2014, 7(6):3-5.
11	刘博，汪明敏，许世广，等. 达芬奇机器人纵隔肿瘤切除术的学习曲线[J]. 中国胸心血管外科临床杂志， 2017, 24(2):127-131.
12	刘星池，许世广，徐惟，等. 达芬奇机器人非小细胞肺癌手术疗效分析[J/CD]. 中华腔镜外科杂志(电子版), 2017，10(2):97-101.
13	张晋昕，李河. 回归分析中定性变量的赋值[J]. 循证医学， 2005, 5(3):169-171.
14	肖雪梦，张应应. 三种回归方法在消除多重共线性及预测结果的比较[J]. 统计与决策， 2015, 24(444):75-78.
15	Meyer M, Gharagozloo F, Tempesta B, et al. The learning curve of robotic lobectomy[J]. International Journal of Medical Robotics & Computer Assisted Surgery, 2012, 8(4):448-452.
16	Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J]. Journal of Thoracic & Cardiovascular Surgery, 2010, 140(1):19-25.
17	Özyurtkan MO, Kaba E, Toker A. What happens while learning robotic lobectomy for lung cancer[J]. Vis Surg, 2017, 3(27):1-4.
18	Velezcubian FO, Ng EP, Fontaine JP, et al. Robotic-assisted videothoracoscopic surgery of the lung[J]. Cancer Control Journal of the Moffitt Cancer Center, 2015, 22(3):314-325.

项目		学习提高阶段(28例)	熟练掌握阶段(81例)	P值
手术时间(min，±s)		216.6±41.8	188.0±24.2	0.002
手术出血量(ml, ±s)		90.7±5.8	57.5±13.4	0.014
术后带管时间(d, ±s)		5.93±2.68	4.42±1.24	0.025
术后住院时间(d，±s)		8.96±2.36	6.06±2.14	0.005
术后并发症[例(%)]		?	?	0.015
?	有	4(14.3)	1(1.2)	?
?	无	24(85.7)	80(98.8)	?
淋巴结清扫数目(枚， ±s)		14.7±8.1	19.2±9.0	0.022

项目		学习提高阶段(28例)	熟练掌握阶段(81例)	P值
手术时间(min，±s)		216.6±41.8	188.0±24.2	0.002
手术出血量(ml, ±s)		90.7±5.8	57.5±13.4	0.014
术后带管时间(d, ±s)		5.93±2.68	4.42±1.24	0.025
术后住院时间(d，±s)		8.96±2.36	6.06±2.14	0.005
术后并发症[例(%)]		?	?	0.015
?	有	4(14.3)	1(1.2)	?
?	无	24(85.7)	80(98.8)	?
淋巴结清扫数目(枚， ±s)		14.7±8.1	19.2±9.0	0.022

[1]	Limin Shang, Mengmeng Zheng, Zhipeng Wang, Yang Yang, Wen Sun, Lei Zhang, Yichen Zhu. Learning curve of modified hand-assisted retroperitoneoscopic living donor nephrectomy [J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(05): 285-291.
[2]	Donggen Jiang, Yao Feng. The learning curve and experiences of modified single-port laparoscopic ligation of patent processus vaginalis by single surgeon in primary hospital [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 560-565.
[3]	Bin Zhang, Daiyu Sun, Xin Hu, Fei Han, Jiuming Li, Gongyu Li, Weili Wu, Baofu Feng, Guohui Peng. Evaluation and comparison of the accuracy of the stone scoring systems in the prediction of stone-free rate after retrograde intrarenal surgery in different surgical experiences [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(04): 353-360.
[4]	Changhua Fang, Lin Du, Xinnan Chen, Hao Wang, Wendi Wang, Chengwei Zhang, Haixiang Qin, Xuefeng Qiu, Junlong Zhuang, Linfeng Xu, Hongqian Guo, Gutian Zhang. Analysis of learning curve of retzius-sparing robot-assisted laparoscopic radical prostatectomy by cumulative summation analysis [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 319-325.
[5]	Yong Wei, Luming Shen, Chen Zhu, Xiangming Cheng, Yunfei Wei, Lin Yuan, Jian Su, Qingyi Zhu. Analysis of single port robot-assisted laparoscopic prostatectomy curve of one single surgeon [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 30-35.
[6]	Kuiyan Zhong, Li Deng, Yuanyang Yao, Kaijian Ling, Yuan Deng, Qiurong Li, Yanzhou Wang. The feasibility and learning curve of laparoendoscopic single-site total hysterectomy using the "chopstick technique" [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(01): 45-50.
[7]	Bin Yan, Huixian Miao, You Wang, Wen Di, Weihua Lou. Comparison of the application of transvaginal natural orifice transluminal endoscopic surgery and trans-umbilical laparoscopic single-site surgery in hysterectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(01): 39-44.
[8]	Chenyu Li, Qingqing He, Dayong Zhuang, Peng Zhou, Tao Yue, Changxiu Shao, Yongxiang Liu, Jing Xu, Xiaolei Li. A prospective study of learning curve of transoral robotic thyroidectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(05): 270-274.
[9]	Miaomiao Zhang, Lei Lei, Shuqin Xu, Jianqi Mao, Jigang Bai, Zhimin Geng, Yi Lyu, Xiaopeng Yan. Analysis of learning curve of magnetic anchoring two-port laparoscopic cholecystectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(01): 77-81.
[10]	Haipeng Chen, Jinzhu Zhang, Xu Guan, Zhixun Zhao, Hengchang Liu, Zheng Jiang, Zheng Liu, Xishan Wang. Analysis of the learning curve of Da Vinci robotic-assisted radical surgery for rectal and sigmoid colon cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(03): 205-208.
[11]	Zhichun Zhang, Yuanda Zhou, Qingsheng Zeng, Peng Li, Hongjie Yang, Yi Sun. The learning curve of fascia space priority approach laparoscopic lateral lymph node dissection in rectal cancer by CUSUM analysis [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(03): 200-206.
[12]	Jiashen Shao, Zhiwu Zhang, Hai Meng, Yong Yang, Qi Fei. Clinical efficacy and surgical learning curve study of unilateral biportal endoscopy unilateral laminectomy bilateral decompression technique in the treatment of lumbar spinal stenosis [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(04): 202-208.
[13]	Xuan Liu, Zhengxia Hu, Xiaodong Wang, Hai Lan, Kainan Li. Learning curve and clinical application value of SuperPATH minimally invasive total hip arthroplasty in the treatment of femoral neck fracture in the elderly [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(02): 73-80.
[14]	Xiaoyun Tan, Jing Zhang, Zhenyin Liu, Kunshan Chen, Jiejun Xia, Ming Zhang, Yiqun Guo, Suiyan Chen. The traditional blind and ultrasound-guided femoral artery puncture in children: a self-controlled cohort study [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(01): 1-5.
[15]	Chengwen Zheng, Tao Hong, Teng Sun, Hao Zhang. Comparison of the learning curve between robotic and thoracoscopic thymectomy [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(01): 15-21.

Please choose a citation manager

Content to export