Impact And Analysis Of Diverse Surgical Robot Training Method On Learning Curve

Background:With the extensive application of surgical robot,the effective training education is paramount to clinical efficacy in robotic surgery.Currently,the Davinci and Micro hand S surgical system are simultaneously applied in clinic in China with diverse training path.However,few studies on the comparison of training effect between these two diverse types of robotic training systems have been reported.This study aims to evaluate the impact of training methods on clinical efficacy through the learning curve of two types of robot-assisted cholecystectomy by means of random controlled trial.Objective:In this study,CUSUM learning curve analysis was conducted on the clinical data of 84 cases of cholecystectomy by Davinci robot and Micro hand S robot,so as to discuss and compare the difference of two diverse surgical robot training system.Methods:From October 2019 to October 2020,we conducted a randomized controlled trial for robot-assisted cholecystectomy performed by two surgeons,who accepted different robotic surgical training respectively before this study.84 consecutive patients with gallbladder diseases who underwent cholecystectomy treatment with Microhand S or Davinci surgical system were randomized assigned to two groups.The primary outcome was surgical success rate(SSR).Secondary outcomes were the operation time(OT),hospital staying,comprehensive complication index(CCI),blood loss(BL),Completeness of the gallbladder specimen.We use the CUSUM analysis compose respective learning curves for comparison between two different robotic surgery.Results:42 patients(male:19%)underwent Davinci robot-assisted cholecystectomy,and 42 patients(male:24%)underwent Micro hand S robot-assisted cholecystectomy.There was no significant difference in SSR,OT,hospital staying,CCI.The robotic set up time of Micro hand S group was significantly less than that of Davinci group,and the number of instrument failures of Davinci group was less than that of Micro hand S group.The learning curves of two groups all reached the highest point when the number of operation cases accumulated to the 14 th case.Before14 cases,the curve continued to rise;after 14 cases,the curve decreased steadily.Taking 14 cases as the dividing point,the learning curve is divided into learning improvement stage and proficiency stability stage.In the subgroup analysis,the console time were significantly higher in Micro hand S group and its robotic set up time was significantly lower than Davinci group in the second half.Conclusion:After the diverse surgical robot system training for two surgeons,the clinical outcomes of robot assisted cholecystectomy in the two groups were basically the same.Using cusum analysis method,it can be obtained that the number of cases where the learning curve of Davinci surgical robot and Micro hand S robot crosses the vertex is 14,while the clinical results are basically the same in the phased subgroup analysis of the learning curve.The training effect of Micro hand S robot training system is non inferior to that of Davinci robot training system.