An appraisal of the learning curve in robotic general surgery

Pernar, Luise I.M.; Robertson, Faith C.; Tavakkoli, Ali; Sheu, Eric G.; Brooks, David; Smink, Douglas S.

doi:10.1007/s00464-017-5520-2

Cited by 126 publications

(93 citation statements)

References 40 publications

(153 reference statements)

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“…Time-based variables were the most common metrics used to assess learning curves, as is the case for other systematic reviews assessing surgical learning curves in other contexts 63,75 . Although common across learning curve analyses, the present review suggests that variation can exist between the learning curve profiles of different metrics for a given procedure, with recovery and safety metrics (LOS, complications) exhibiting substantially longer learning curves than those for operating time, often with continued improvement for extended periods of time after the learning curve for operating time has been overcome.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of learning curves in robot-assisted surgery

et al. 2020

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Background: Increased uptake of robotic surgery has led to interest in learning curves for robot-assisted procedures. Learning curves, however, are often poorly defined. This systematic review was conducted to identify the available evidence investigating surgeon learning curves in robot-assisted surgery.Methods: MEDLINE, Embase and the Cochrane Library were searched in February 2018, in accordance with PRISMA guidelines, alongside hand searches of key congresses and existing reviews. Eligible articles were those assessing learning curves associated with robot-assisted surgery in patients.Results: Searches identified 2316 records, of which 68 met the eligibility criteria, reporting on 68 unique studies. Of these, 49 assessed learning curves based on patient data across ten surgical specialties. All 49 were observational, largely single-arm (35 of 49, 71 per cent) and included few surgeons. Learning curves exhibited substantial heterogeneity, varying between procedures, studies and metrics. Standards of reporting were generally poor, with only 17 of 49 (35 per cent) quantifying previous experience. Methods used to assess the learning curve were heterogeneous, often lacking statistical validation and using ambiguous terminology.Conclusion: Learning curve estimates were subject to considerable uncertainty. Robust evidence was lacking, owing to limitations in study design, frequent reporting gaps and substantial heterogeneity in the methods used to assess learning curves. The opportunity remains for the establishment of optimal quantitative methods for the assessment of learning curves, to inform surgical training programmes and improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Systematic review of learning curves in robot-assisted surgery

et al. 2020

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“…In our opinion, 10 robotic resections are insufficient to consider the surgeon fully trained. A recent meta‐analysis showed the robotic learning curve for colorectal surgery ranged from a minimum of 19 to 128 cases . Less training may be required for the equivalent laparoscopic procedure yet the number of cases required was the same in the study, creating a bias in favour of laparoscopic surgery.…”

Section: Arguments For (Khan Banerjee Kim)mentioning

confidence: 99%

Robotic rectal surgery has advantages over laparoscopic surgery in selected patients and centres

et al. 2018

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“…As expected, robotic operative times decreased over the course of the study and without any detriment on the primary outcome. While the robotic platform is generally accepted to have a quicker learning curve than laparoscopic surgery, [11][12][13] our data suggest that laparoscopic skilled surgeons can transition to the robotic platform without compromising perioperative outcomes.…”

Section: Discussionmentioning

confidence: 79%

Sigmoidectomy for Diverticulitis—A Propensity-Matched Comparison of Minimally Invasive Approaches

Ogilvie

Saunders

Parker

et al. 2019

Journal of Surgical Research

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a b s t r a c tBackground: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication. Methods:We identified all elective cases of laparoscopic-and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges.Results: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P ¼ 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P ¼ 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P ¼ 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P ¼ 0.62 and 3.8 versus 3.3, P ¼ 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P ¼ 0.70). In the robotic arm operating room charges were slightly more ($2835 AE $394 versus $2196 AE $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001).Conclusions: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic-and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use. ª

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An appraisal of the learning curve in robotic general surgery

Cited by 126 publications

References 40 publications

Systematic review of learning curves in robot-assisted surgery

Systematic review of learning curves in robot-assisted surgery

Robotic rectal surgery has advantages over laparoscopic surgery in selected patients and centres

Sigmoidectomy for Diverticulitis—A Propensity-Matched Comparison of Minimally Invasive Approaches

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