Objectives: To explore the efficacy of robotic-assisted retroperitoneal benign tumor resection and to analyze its learning curve. Methods: This is a retrospective case series study. The data of patients who underwent robotic-assisted retroperitoneal benign tumor resection from August 2015 to February 2023 at the Department of Retroperitoneal Tumor Surgery was analyzed retrospectively. There were 24 males and 45 females, with an age of (46.3±10.6) years (range: 19 to 76 years). The perioperative data, postoperative pathological results, and follow-up data were recorded. The cumulative sum (CUSUM) method was used to analyze the robotic system setup time and operative time to plot the learning curve. A linear regression model was applied to determine the best-fit curve, selecting the model with the highest R² value. Based on the vertex of the learning curve for surgical time, the patients were divided into a learning group and a mastery group. The general data and perioperative conditions of the two groups were compared. Independent sample t-tests, Mann-Whitney U tests, and χ2 tests were used for comparisons. Results: All 69 patients successfully completed the surgery without intraoperative complications. The diameter of tumors was (49.7±18.6) mm (range: 16 to 131 mm). The setup time for the robotic surgical system was (35.3±9.8) minutes (range: 20 to 61 minutes); the surgical time was (169.2±36.5) minutes (range: 70 to 305 minutes); intraoperative blood loss (M(IQR)) was 10.0 (15.0) ml (range: 2.0 to 200.0 ml). The tumors in 32 patients (46.4%) were adherent to major blood vessels. All patients were discharged without complications. The follow-up period lasted until February 2024, and no patients required reoperation, readmission, or died due to retroperitoneal benign tumors. There were no severe long-term complications, and no radiological evidence of tumor recurrence was found. The best-fit equation for the learning curve based on surgical time was CUSUM=0.010X³-1.648X²-68.573X-61.091, and the best-fit equation for the learning curve based on robotic system setup time was CUSUM=0.0018X³-0.285X²+10.460X+57.541 (where X represents the number of surgeries). The R² values of 2 learning curve models were 0.953 and 0.957, respectively, and the fit model tests had P<0.05. The inflection point of the learning curve based on surgical time was the 28th case, which is considered the minimum number of surgeries required to achieve proficiency in robotic-assisted retroperitoneal benign tumor resection. Based on this, the patients were divided into a learning group (cases 1 to 28) and a mastery group (cases 29 to 69). The surgical time for the learning group was significantly longer than that of the mastery group ((194.7±30.0) minutes vs. (151.9±31.4) minutes, t=4.126,P<0.01). No statistically significant differences were found for other parameters (all P>0.05). Conclusions: Robotic-assisted retroperitoneal benign tumor resection is feasible. The minimum number of surgeries required to achieve proficiency in overcoming the learning curve is about 28 cases.
目的： 探讨机器人辅助腹膜后良性肿瘤切除术的治疗效果及学习曲线。 方法： 本研究为回顾性病例系列研究。回顾性分析2015年8月至2023年2月在青岛大学附属医院腹膜后肿瘤外科接受机器人辅助腹膜后良性肿瘤切除术的69例患者资料。其中男性24例，女性45例，年龄（46.3±10.6）岁（范围：19~76岁），记录患者的围手术期情况、术后病理学结果、随访情况等。采用累积和分析法（CUSUM）绘制机器人手术系统的安装时间和手术时间的学习曲线，对学习曲线进行分析，绘制线性拟合曲线，选取决定系数（R2值）最大的模型为最佳拟合模型。以基于手术时间的学习曲线顶点为界，将69例患者分为学习组和掌握组，比较两组患者的一般资料及围手术期情况等。采用独立样本t检验、Mann-Whitney U检验或χ2检验对数据进行比较。 结果： 69例患者均顺利完成手术，无术中并发症发生。肿瘤最大径为（49.7±18.6）mm（范围：16~131 mm），机器人手术系统的安装时间为（35.3±9.8）min（范围：20~61 min），手术时间为（169.2±36.5）min（范围：70~305 min），术中出血量［M（IQR）］为10.0（15.0）ml（范围：2.0~200.0 ml）。肿瘤黏附大血管32例（46.4%）。患者均顺利出院。随访时间截至2024年2月，随访期间无患者因腹膜后良性肿瘤而需要再次手术、再次入院、死亡，患者无严重远期并发症，无肿瘤复发的影像学证据。基于手术时间的学习曲线最佳拟合方程为CUSUM=0.010X3-1.648X2+68.573X-61.091，基于机器人手术系统安装时间的学习曲线最佳拟合方程为CUSUM=0.0018X3-0.285X2+10.460X+57.541（X为手术例数）。2个学习曲线的拟合优度的R2值分别为0.953和0.957，拟合方程检验均P<0.05。基于手术时间的学习曲线拐点为第28例，以第28例为界，分为学习组（第1~28例）和掌握组（第29~69例），学习组的手术时间长于掌握组［（194.7±30.0）min比（151.9±31.4）min，t=4.126，P<0.01］，其余参数的差异均无统计学意义（P值均>0.05）。 结论： 机器人辅助腹膜后良性肿瘤切除术的治疗效果较为满意，跨越学习曲线达到熟练掌握阶段所需要累积的手术例数约为28例。.