关键词: 静脉解剖, 标准化手术流程, 机器人辅助手术, 肾部分切除术, 学习曲线

Abstract: Objective   To evaluate the value of establishing a standard operating procedure(SOP) based on the venous anatomy system to improve the learning curve of robotic-assisted laparoscopic partial nephrectomy(VAB-RAPN).  Methods   The clinicopathological data of 40 consecutive patients who underwent RAPN were collected.Patients were divided into Group A,B,C,and D,with 10 cases in each group.All procedures were completed by a single surgeon.Our procedure is to perform the operation by identifying the landmark of the gonadal vein,inferior vena cava,renal vein,and lumbar vein.The differences in operation time(OT),renal warm ischemia time(WIT),estimated blood loss(EBL),time of drainage removed,positive surgical margins(PSM) and operative complications were compared.And the significance of the groups was statistically analyzed.  Results   All the patients successfully underwent the operation.The average OT of the 40 patients was 114.25 ± 30.65 min.The average renal WIT was 22.5 ± 7.42 min.And the average EBL was 290 ± 314.44 ml.With the accumulation of surgical cases,the OT of groups A,B,C,and D gradually shortened,which were 142 min,122 min,107 min,and 87 min.The WIT gradually shortened,which were 30 min,23 min,22 min,and 18 min.The time of drainage removed was 5.9 d,6.1 d,5.6 d,and 5.1 d.The EBLs in group D were 335 ml,330 ml,335 ml,and 160 ml.No significant difference had been found in drainage removal and post-operative complications.  Conclusion   By conducting the standard operating procedures,the junior surgeon can manipulate the RAPN in 10 cases.After 20 cases,the surgeon has mastered the core skills of RAPN.After 30 cases,the surgeon can manage the procedure skillfully.The learning curve shows a significant decline after 30 cases.And it can help to save the OT and WIT,and reduce intraoperative EBL.The VAB-RAPN standard procedure in our center is worth being recommended.

Key words: venous anatomy, standard operating procedure, robotic-assisted laparoscopic surgery, partial nephrectomy, learning curve