Abstract：
As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: \"robot*\", \"surgery\", \"volume\" and \"outcome\" was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.
摘要：
随着机器人辅助手术（RAS）扩展到更小的中心，平台在专业之间共享。医疗保健提供者必须考虑病例数量和组合，以保持质量和成本效益。这可以被告知，部分,通过数量-结果关系。我们进行了系统评价，以描述腹内机器人辅助手术中的体积与结果的关系，以报告建议的最小体积标准。Medline的文献检索,很好的证据搜索,健康技术评估数据库和Cochrane图书馆使用以下术语：“机器人*”，\"手术\",执行了“卷”和“结果”。包括的手术是妇科：子宫切除术，泌尿外科：部分和根治性肾切除术，膀胱切除术,前列腺切除术,和普通外科：结肠切除术，食管癌切除术.分析医院和外科医生的体积测量和所有报告的结果。41项研究，包括983,149个程序，符合纳入标准。使用纽卡斯尔-渥太华质量评估量表评估研究质量，并在叙述性综述中综合检索到的数据。描述了与关键结果指标相关的重要数量-结果关系，包括手术时间,并发症,正利润率，淋巴结产量和成本。描述了年度外科医生和医院容量阈值。我们得出的结论是，在给定程序的年度病例少于10例的中心，让多名外科医生执行这些手术会导致更糟糕的结果，因此,应寻求执行其他免费机器人程序或进行联合案例的机会。
