Learning curve for robotic-assisted laparoscopic colorectal surgery

Abstract

BackgroundRobotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of colorectal surgery. We aimed to evaluate the learning curve for RALS procedures involving resections of the rectum and rectosigmoid.MethodsA series of 50 consecutive RALS procedures were performed between August 2008 and September 2009. Data were entered into a retrospective database and later abstracted for analysis. The surgical procedures included abdominoperineal resection (APR), anterior rectosigmoidectomy (AR), low anterior resection (LAR), and rectopexy (RP). Demographic data and intraoperative parameters including docking time (DT), surgeon console time (SCT), and total operative time (OT) were analyzed. The learning curve was evaluated using the cumulative sum (CUSUM) method.ResultsThe procedures performed for 50 patients (54% male) included 25 AR (50%), 15 LAR (30%), 6 APR (12%), and 4 RP (8%). The mean age of the patients was 54.4 years, the mean BMI was 27.8 kg/m2, and the median American Society of Anesthesiologists (ASA) classification was 2. The series had a mean DT of 14 min, a mean SCT of 115.1 min, and a mean OT of 246.1 min. The DT and SCT accounted for 6.3% and 46.8% of the OT, respectively. The SCT learning curve was analyzed. The CUSUMSCT learning curve was best modeled as a parabola, with equation CUSUMSCT in minutes equal to 0.73 × case number2 − 31.54 × case number − 107.72 (R = 0.93). The learning curve consisted of three unique phases: phase 1 (the initial 15 cases), phase 2 (the middle 10 cases), and phase 3 (the subsequent cases). Phase 1 represented the initial learning curve, which spanned 15 cases. The phase 2 plateau represented increased competence with the robotic technology. Phase 3 was achieved after 25 cases and represented the mastery phase in which more challenging cases were managed.ConclusionsThe three phases identified with CUSUM analysis of surgeon console time represented characteristic stages of the learning curve for robotic colorectal procedures. The data suggest that the learning phase was achieved after 15 to 25 cases.

Robotic and laparoscopic surgeries for colorectal cancer: learning curve and short-term outcomes

“…Наши результаты по ЛС операциям в целом соответствуют данным литературы, согласно которым КО в ЛС колоректальной хирургии оценивается в диа-пазоне от 30 до 70 случаев [19][20][21][22]. Что касается КО для РА операций, в нашей работе этот показатель оказался относительно выше, чем было продемонстри-ровано в предыдущих исследованиях, где сообщалось, что КО РА колоректальной хирургии составляет от 15 до 35 случаев [23][24][25]. M. B. Bokhari и соавт.…”

“…M. B. Bokhari и соавт. [23] после анализа с помощью CUSUM 50 операций предположи-ли, что КО РА колоректальной хирургии была достигну-та в 15-25 случаях с 3 этапами обучения. Соглас-но R. M. Jimenez-Rodriguez и соавт.…”

Gynecological Surgery and the Robot

“…Three distinct phases exist in the learning curves associated with robot-assisted surgery [96]. With regard to colorectal surgery the first phase or the initial phase occurred over the first 15 cases during this phase the operating time decreased.…”

Laparoscopic Surgery for Rectal Cancer: Approaches, Challenges and Outcome

“…The learning curve of robotic assisted technology entails the surgeon's mastery of several unique skills to overcome the loss of tensile and tactile feedback by recognizing visual cues, conceptualize the spatial relationships of robotic instruments outside the active field of view www.intechopen.com and mentally visualizing the spatial relationships of the robotic arms and cart while operating at the console (Bokhari et al, 2011). Bokhari et al (2011) believe that to facilitate the acquisition of robotic unique skills in a safe and stepwise manner, the surgeon should acquire expert laparoscopic skills before using the robotic approach.…”

“…Bokhari et al (2011) believe that to facilitate the acquisition of robotic unique skills in a safe and stepwise manner, the surgeon should acquire expert laparoscopic skills before using the robotic approach. They divided the learning curve into three phases.…”