Evaluation of the learning curve for totally robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy by CUSUM analysis

Abstract

Single-anastomosis duodenal–ileal bypass with sleeve gastrectomy (SADI-S) has similar efficacy and lower complication rate in the treatment of morbid obesity and obesity-associated metabolic diseases compared with the biliopancreatic diversion with a duodenal switch. The use of a robotic surgical system reduces surgical difficulties and improves surgical outcomes. The learning curve reflects the rate of skills or knowledge acquired in a certain period of time. However, the learning curve for robotic SADI-S has not been estimated.We used the cumulative sum analysis method to investigate the learning curve of totally robotic SADI-S. Textbook outcome analysis was performed to comprehensively define surgical success or failure.Multivariate analysis was performed to predict independent risk factors for complications and operative time. The moving average method was used to reflect the trends in operative time.This study showed that the learning curve for totally robotic SADI-S was 27 cases. Surgeon experience (case number and successful case number) was an independent predictor of the total operative time. A successful case number was the only independent predictor of surgical success or failure in this study (β = 0.084; P = 0.001). Except for the first assistant level, scrubbed nurse level, operative time, and proportion of abdominal drainage tube, there was no significant difference between the learning stage and mastery stage groups.The learning curve for totally robotic SADI-S was 27 cases. Surgeon experience including case number and successful case number were identified as independent predictors affecting the total operative time. A successful case number was the only independent predictor of surgical success or failure.