Clinical Comparison And Learning Curve Analysis Between Robotic And Conventional Laparoscopic Radical Operation For Early Cervical Cancer

Objective:To analyze the learning curve of robot-assisted laparoscopic radical resection of early cervical cancer by using the cumulative sum analysis method(CUSUM)with the operative time as the index,and to compare the perioperative effect of robot-assisted laparoscopic radical resection of cervical cancer with conventional laparoscopic,so as to provide guidance for clinical treatment and technical learning of physicians and provide reference basis.Methods:According to the inclusion and exclusion criteria,a total of 136 patients with Da Vinci robot-assisted laparoscopic radical cervical cancer(75 patients)and conventional laparoscopic radical cervical cancer(61 patients)performed by the same surgical team in the Department of the First Affiliated Hospital of Gannan Medical University from August 2019 to October 2022 were retrospectively collected.The Cumulative Sum(CUSUM)analysis was used to construct the learning curve of robot-assisted laparoscopic radical resection of early cervical cancer.Based on the number of cases corresponding to the turning point of the learning curve,75 patients with robotic surgery were divided into the learning group and the skilled group.SPSS25.0 statistical analysis was used to compare the age,body mass index(BMI),preoperative comorbidities,pelvic surgery history,disease stage,pathological type and other basic data of the two groups.Operative time,number of lymph nodes cleared,intraoperative blood loss,intraoperative complications,postoperative pelvic drainage volume,indenture time of drainage tube,postoperative short-term complications,hospitalization costs and other relevant surgical indexes.The clinical data of 61 patients in the conventional laparoscopic surgery group and the robot skilled group were compared and analyzed.Results:1、All patients in the robot group successfully completed robot-assisted laparoscopic radical resection of cervical cancer,the longest operation time was 445min,the shortest was 190min,and the average operation time was:277.28min. According to CUSUM accumulation and analysis method,the operation time was used as the index to draw a learning curve.The fitting curve R2=0.974,P=0.000 <0.01,and the equation was Y=1.43E2+89.55*X-2.4*X~2+0.02*X~3.The curve showed a turning direction from the 25nd operation.2、Robot skilled group vs.routine laparoscopic group,robot learning group vs. skilled group:There were no significant differences in age,BMI,preoperative complications,pelvic surgery history,disease stage and pathological type among comparison groups(P>0.05).3、Compared with the learning group,the skilled group had shorter operation time (254.56±33.37min vs 322.72±46.66min,P<0.001)and less intraoperative double j ureteral catheter placement[2 cases(4.0%)vs 6 cases(24.0%),P=0.025].The difference was statistically significant(P<0.05).There were no significant differences in the amount of intraoperative blood loss,the number of intraoperative lymph nodes removed,the number of intraoperative blood transfusions,pelvic drainage volume,indwelling time of drainage tube and postoperative hospital stay between the two groups(P>0.05).Compared with the conventional laparoscopic group,the operation time of the robot skilled group was shorter(254.56±33.37min vs 277.34±40.09min,P=0.002)and the intraoperative blood loss was less[100(20,150)ml vs 100(50,200)ml,P=0.005]. The number of intraoperative double j ureteral catheter insertion cases was less[2 cases(4.0%)vs 10 cases(16.4%),P=0.036],and the overall hospitalization cost was higher(46830.06±3152.31 yuan vs 33568.97±3744.71 yuan,P<0.001),the difference was statistically significant(P<0.05).There were no significant differences in the number of lymph nodes removed,the number of intraoperative blood transfusions,pelvic drainage volume,indwelling time of drainage tube and postoperative hospital stay between the two groups(P>0.05).4、The incidence of postoperative complications in the robot skilled group (11/50,22.0%)was lower than that in the common laparoscopic group (25/61,41.0%),and the difference was statistically significant(χ2=4.519, P=0.034).However,there was no significant difference in any single postoperative complication(lymphatic cyst,intestinal obstruction,vesico-vaginal fistula,poor prognosis of stump,pulmonary embolism,venous embolism of lower extremity,urinary tract infection and urinary retention)between the two groups(P>0.05).There was no significant difference in postoperative complications between robot proficiency group and learning group(P>0.05).Conclusion:1.It takes about 25 surgeries for robot-assisted laparoscopic radical resection of early cervical cancer to reach the proficient and stable stage,which is less than conventional laparoscopic surgery,and relatively proficient level can be achieved through less operations.This learning curve can guide and plan the surgical learning of the surgeons.2.Both robot-assisted laparoscopic and conventional laparoscopic radical resection of cervical cancer are safe and effective in the treatment of early cervical cancer. The former has less operation time,intraoperative blood loss and double J tube insertion,and has more advantages in urinary system protection and postoperative bladder function recovery,which is worthy of promotion in surgical operations.