Clinical efficacy analysis and learning curve of the robot-assisted Warshaw procedure using the da Vinci system
10.3760/cma.j.cn113884-20241125-00346
- VernacularTitle:达芬奇机器人辅助Warshaw术的临床疗效分析以及学习曲线研究
- Author:
Hongliang LIU
1
;
Qisheng HAO
;
Xi WANG
;
Mengxing CHENG
;
Fabo QIU
;
Lantian TIAN
;
Bin ZHOU
;
Hao ZOU
Author Information
1. 青岛大学附属医院肝胆胰外科，青岛 266000
- Publication Type:Journal Article
- Keywords:
Pancreatic neoplasms;
Robot;
Warshaw procedure;
Efficacy;
Learning curve
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(2):96-100
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical efficacy and learning curve of robotic-assisted Warshaw procedure using the da Vinci system.Methods:Clinical data of 91 consecutive patients with pancreatic body and tail lesions undergoing robotic-assisted Warshaw procedure at Qingdao University Affiliated Hospital from October 2021 to April 2023 were retrospectively analyzed, including 21 males and 70 females, aged (50.2±14.3) years. Patient characteristics, operative time, and intraoperative blood loss were recorded. The learning curve was constructed using cumulative sum (CUSUM) analysis, with case number on the x-axis and CUSUM values on the y-axis. Linear fitting was performed, and the model with the highest determination coefficient was selected as the optimal fitting model. The learning process was divided into two phases based on the inflection point of the CUSUM learning curve: the learning phase and the proficiency phase. Perioperative outcomes were compared between these two phases.Results:All 91 procedures were successfully completed using the da Vinci robotic system with R0 resection margins. There were no perioperative mortalities or reoperations due to postoperative splenic infarction. The operative time was (227.84±76.68) min. The optimal fitting equation for the CUSUM learning curve was: CUSUM=0.005 640X 3-1.501X 2+ 92.59X-183.1. The CUSUM learning curve showed an inflection point at case 39, dividing the learning process into the learning phase (cases 1-39) and proficiency phase (cases 40-91). Compared to the learning phase, the proficiency phase demonstrated significantly shorter operative time [(203.0±75.6) min vs. (260.9±65.5) min], less intraoperative blood loss [50.0 (20.0, 50.0) ml vs. 100.0 (50.0, 100.0) ml], and reduced postoperative drainage duration [(8.7±2.4) d vs. (10.8±3.2) d] (all P<0.05). Conclusion:The robotic-assisted Warshaw procedure feasible for patients with pancreatic body and tail lesions. Surgeons require approximately 39 cases to complete the learning curve and achieve proficiency in this procedure.
