Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

Abstract

Background Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. Methods We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. Results The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. Conclusion Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.

Tele‐proctoring for minimally invasive surgery across Japan: An initial step toward a new approach to improving the disparity of surgical care and supporting surgical education

“…Surgical education using annotation was shown to be useful with da Vinci surgery. 21 , 22 , 23 As illustrated by the questionnaire results, surgical quality, educational effect, and social impact all received positive responses, and the educational effect of tele‐proctoring seems to be very promising. Verifying the differences in the questionnaire results between large and small latency—although there was a positive correlation between the distance between two locations and total latency—revealed no significant differences in the questionnaire results between the two groups for all latencies measured in this study.…”

“…These results may be due to the two‐way communication of tele‐proctoring and the ability to provide annotation guidance in real‐time. Surgical education using annotation was shown to be useful with da Vinci surgery 21‐23 . As illustrated by the questionnaire results, surgical quality, educational effect, and social impact all received positive responses, and the educational effect of tele‐proctoring seems to be very promising.…”

Learning curve for robotic-assisted rectal surgery by a single surgeon

“…Yamaguchi et al reported that the learning curve for robotic surgery is stable after 15-45 cases, and few individual differences occur [6][7][8] . Many overseas reports have also shown that the operating time is shortened, and complications were reduced in 20-30 cases [9][10][11] . In our series, the operative time was reduced and reached a plateau in the first nine cases.…”

Dual console operating in robotic surgery – a show off or a real necessity?

“…A Japanese study [7] evaluating short‐term outcomes and learning curve of an inexperienced laparoscopic rectal cancer surgeon performing robotic rectal cancer surgery reported the benefit from the use of the dual console during the first part of the learning curve. The first 15 cases were proctored with a dual console while the remaining 24 cases were performed independently.…”