Abstract：
With an increase in robot-assisted surgery across all specialties, adequate training and credentialing strategies need to be identified to ensure patients safety. The meta-analysis assesses the transferability of technical surgical skills between laparoscopic surgery, open surgery, and robot-assisted surgery.
A systematic search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Outcomes were categorized into time, process, product, and composite outcome measures and pooled separately using Hedges\'g (standardized mean difference [SMD]). Subgroup analyses were performed to assess the effect of study design, virtual reality platforms and task difficulty.
Out of 14,120 screened studies, 30 were included in the qualitative synthesis and 26 in the quantitative synthesis. Technical surgical skill transfer was demonstrated from laparoscopic to robot-assisted surgery (composite: SMD 0.40, 95%-confidence interval [CI] [0.19; 0.62], time: SMD 0.62, CI [0.33; 0.91]) and vice versa (composite: SMD 0.66, CI [0.33; 0.99], time [basic skills]: SMD 0.36, CI [0.01; 0.72]). No skill transfer was seen from open to robot-assisted surgery with limited available data.
Technical surgical skills can be transferred from laparoscopic to robot-assisted surgery and vice versa. Robot-assisted and laparoscopic surgical skills training and credentialing should not be regarded separately, but a reasonable combination could shorten overall training times and increase efficiency. Previous experience in open surgery should not be considered as an imperative prerequisite for training in robot-assisted surgery. Recommendations for studies assessing skill transfer are proposed to increase comparability and significance of future studies.
PROSPERO CRD42018104507.
A systematic search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Outcomes were categorized into time, process, product, and composite outcome measures and pooled separately using Hedges\'g (standardized mean difference [SMD]). Subgroup analyses were performed to assess the effect of study design, virtual reality platforms and task difficulty.
Out of 14,120 screened studies, 30 were included in the qualitative synthesis and 26 in the quantitative synthesis. Technical surgical skill transfer was demonstrated from laparoscopic to robot-assisted surgery (composite: SMD 0.40, 95%-confidence interval [CI] [0.19; 0.62], time: SMD 0.62, CI [0.33; 0.91]) and vice versa (composite: SMD 0.66, CI [0.33; 0.99], time [basic skills]: SMD 0.36, CI [0.01; 0.72]). No skill transfer was seen from open to robot-assisted surgery with limited available data.
Technical surgical skills can be transferred from laparoscopic to robot-assisted surgery and vice versa. Robot-assisted and laparoscopic surgical skills training and credentialing should not be regarded separately, but a reasonable combination could shorten overall training times and increase efficiency. Previous experience in open surgery should not be considered as an imperative prerequisite for training in robot-assisted surgery. Recommendations for studies assessing skill transfer are proposed to increase comparability and significance of future studies.
PROSPERO CRD42018104507.
摘要：
背景：随着所有专业的机器人辅助手术的增加，需要确定适当的培训和认证策略，以确保患者安全。荟萃分析评估了腹腔镜手术之间技术手术技能的可转移性，开放手术,和机器人辅助手术。
方法：在Medline进行了系统搜索，Cochrane中央控制试验登记册,和WebofScience。结果被归类为时间，process,产品,和复合结果测量值，并使用Hedges\'g(标准化平均差[SMD])单独汇总。进行亚组分析以评估研究设计的效果，虚拟现实平台和任务难度。
结果：在14,120项筛选研究中，在定性合成中包括30个,在定量合成中包括26个。已证明从腹腔镜手术到机器人辅助手术的技术手术技能转移（复合：SMD0.40，95％-置信区间[CI][0.19;0.62]，时间：SMD0.62，CI[0.33;0.91]），反之亦然（复合：SMD0.66，CI[0.33;0.99]，时间[基本技能]：SMD0.36，CI[0.01；0.72]）。在可用数据有限的情况下，没有从开放到机器人辅助手术的技能转移。
结论：技术手术技能可以从腹腔镜转移到机器人辅助手术，反之亦然。机器人辅助和腹腔镜手术技能培训和认证不应单独考虑，但是合理的组合可以缩短整体训练时间并提高效率。以前的开放手术经验不应被视为机器人辅助手术培训的必要条件。提出了评估技能转移的研究建议，以增加可比性和未来研究的意义。
■PROSPEROCRD42018104507。
方法：在Medline进行了系统搜索，Cochrane中央控制试验登记册,和WebofScience。结果被归类为时间，process,产品,和复合结果测量值，并使用Hedges\'g(标准化平均差[SMD])单独汇总。进行亚组分析以评估研究设计的效果，虚拟现实平台和任务难度。
结果：在14,120项筛选研究中，在定性合成中包括30个,在定量合成中包括26个。已证明从腹腔镜手术到机器人辅助手术的技术手术技能转移（复合：SMD0.40，95％-置信区间[CI][0.19;0.62]，时间：SMD0.62，CI[0.33;0.91]），反之亦然（复合：SMD0.66，CI[0.33;0.99]，时间[基本技能]：SMD0.36，CI[0.01；0.72]）。在可用数据有限的情况下，没有从开放到机器人辅助手术的技能转移。
结论：技术手术技能可以从腹腔镜转移到机器人辅助手术，反之亦然。机器人辅助和腹腔镜手术技能培训和认证不应单独考虑，但是合理的组合可以缩短整体训练时间并提高效率。以前的开放手术经验不应被视为机器人辅助手术培训的必要条件。提出了评估技能转移的研究建议，以增加可比性和未来研究的意义。
■PROSPEROCRD42018104507。
