Study On Learning Curve Of Da Vinci Robot Assisted Low Anterior Rectal Resectionexcision

Objective:To explore the learning curve of the fourth generation Da Vinci robot assisted low anterior resection(LAR)application in order to provide reference for the popularization of robot assisted LAR.Methods:The clinical data of 45 patients with low rectal cancer diagnosed in the Department of intestinal surgery of Three Gorges Hospital Affiliated to Chongqing University from June 29,2019 to July 28,2020 were retrospectively analyzed.All patients underwent the fourth generation Da Vinci robot assisted LAR.The time of operation was draw-n and the operation time curve was analyzed by cumulative sum analysis(CUSUM).The CUSUM learning curve was fitted and the goodness of fit was judged by R2.The operation time,intraoperative blood loss,number of lymph node dissection,postoperative abdominal drainage volume,postoperative feeding time,drainage tube removal time,postoperative discharge time and postoperative complications were compared.Results:The robot assisted LAR operation time decreased with the accumulation of operation times.The best fitting curve was cubic curve,the goodness of fit coefficient R2=0.842,and the fitting equation was CUSUM(n)=40.390+12.993×n-0.269×n2-0.001×n3(n is the number of surgical cases).The fitting learning curve reached the peak when the number of operations accumulated to the 27th case,and the learning curve was divided into two stages in this case:the ascending stage and the plateau stage.The differences of operation time(P=0.002)and intraoperative blood loss(P=0.038)were statistically significant.Conclusion:The learning curve of Da Vinci robot lobectomy is analyzed accurately by CUSUM analysis method,which shows that 27 cases need to be accumulated to master the technology.The operation time and blood loss can be used as the main indexes.