| BackgroundCervical cancer is one of the most common gynecological malignancies.Every year,there are more than 500,000 new cases of cervical cancer in the world.According to the statistical data of the world health organization,China accounts for 28%of the new cases in the world and 50%in Asia,and 1/3 to 1/4 of the deaths in Asia.With the popularization of cervical cancer screening,it has been found that the incidence of cervical cancer in recent years is on the rise and getting younger.At present,based on the operation of the comprehensive treatment is still the main treatment approaches for patients with cervical cancer,leonardo Da Vinci robots with its unique advantages,occupy the important position in laparoscopic minimally invasive surgery,compared with the ordinary laparoscopic surgery,slightly long operation time,less blood loss,shorter hospital stay,remove lymph node number and for nerve to identify the more clear,micro,lower incidence of postoperative complications.At the same time,Da Vinci robot,with its advantages of simple operation,short learning cycle and rapid growth of surgeons,has been rapidly promoted and applied in the treatment of cervical cancer surgery,and has been widely praised in clinical practice.In order to further promote its development in clinical surgery,this paper makes an in-depth study on the clinical application effect and application experience of Da Vinci robot in our hospitalObjectiveIn this study,CUSUM learning curve analysis was conducted on the clinical data of 69 cases of extensive hysterectomy for cervical cancer performed by Da Vinci robot,so as to discuss how to improve the application effect of Da Vinci robot under the guidance of learning curve.MethodRetrospective analysis was performed on the clinical data of 69 cases of Da Vinci robotic cervical cancer patients in the same treatment group of gynecology department of the first affiliated hospital of Zhengzhou university from January 2018 to October 2019.Cumulative sum(CUSUM)analysis was performed on the operation time of the first to the 50th cases by using the conventional method of extensive hysterectomy of cervical cancer by Da Vinci robot,and the learning curve was obtained by fitting.Taking the number of cases corresponding to the highest point of the curve as the limit,the 50 patients were divided into the study and exploration group and the proficiency and stability group.The two groups of patients included in the study were compared in terms of operation time(from skin resection to robot docking to operation completion),total blood loss,number of lymph nodes removed during the operation(pelvic lymph nodes),postoperative complications,postoperative hospital stay,extubation time and postoperative exhaust time.The clinical data of the 51-69 patients who underwent extensive hysterectomy of cervical cancer with modified doi Da Vinci robot were compared with the clinical data of the patients at the same stage of proficiency stabilization.ResultsThe average total operation time of extensive hysterectomy for cervical cancer by Da Vinci robot was 229.74±31.07 min,the average docking time of Da Vinci robot system was 32.40±7.284 min,and the average operation time was 197.34±25.20 min.The learning curve of CUSUM was obtained by optimal fitting,that is,CUSUM=0.0173x3-1.960x2+54.464x-27.046(x is the number of cases),the coefficient of goodness of fit R2=0.973,P<0.05.The slope of the fitting curve changed from positive to negative when the number of cases reached to the 19th case.The learning curve was divided into learning improvement stage and proficiency stabilization stage with 19 cases as the cut-off point.The differences in operation time(P<0.01),intraoperative blood loss(P<0.01),postoperative hospital stay(P<0.05)and removal time of abdominal drainage tube(P<0.05)between the two groups were statistically significant.The clinical data of the patients treated with the improved method were compared and analyzed with the clinical data of the patients at the same stage of proficiency stabilization.Except for the longer operation time(P<0.05),there were no statistical differences in intraoperative blood loss(P>0.01),postoperative hospital stay(P>0.05),and removal time of abdominal drainage tube(P>0.05).Conclusion1.The CUSUM analysis method can be used to obtain the learning curve of Da Vinci robot's extensive hysterectomy and calculate the crossing point value,which can be used to guide clinical application and make corresponding preparations for the operation at different stages.2.Indications should be strictly controlled in minimally invasive surgery for cervical cancer,and the principle of "no tumor" should be throughout the operation process.Scholars should be encouraged to actively explore the surgical method of Da Vinci robot to avoid extensive resection of uterine cervical cancer,so as to achieve better clinical results. |
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