Robotic sphincter saving rectal cancer surgery: A learning curve analysis

Aghayeva, Afag; Baca, Bilgi

doi:10.1002/rcs.2112

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…We observed an accelerated learning curve for robotic surgery, with the surgeon achieving proficiency after just 17 cases. Similarly, previous studies have found that the learning curve for rectal cancer surgery with the da Vinci robot was 15–50 cases [ 16 – 18 ]. The accelerated learning curve for RTME can be explained as follows.…”

Section: Discussionsupporting

confidence: 92%

Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: a retrospective study

Wang

et al. 2021

BMC Gastroenterol

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Background The Micro Hand S robot is a new surgical tool that has been applied to total mesorectal excision (TME) surgery for rectal cancer in our center. In this study, we compared the operative outcomes, functional outcomes and learning curves of the Micro Hand S robot-assisted TME (RTME) with laparoscopic TME (LTME). Methods A total of 40 patients who underwent RTME and 65 who underwent LTME performed by a single surgeon between July 2015 and November 2018 were included in this retrospective study. Clinicopathologic characteristics, operative and functional outcomes, and learning curves were compared between the two groups. The learning curve was analyzed using the cumulative sum method and two stages (Phase 1, Phase 2) were identified and analyzed. All patients were followed up for at least 12 months. Results The clinicopathologic characteristics of the two groups were similar. The learning curve was 17 cases for RTME and 34 cases for LTME. Compared with LTME, RTME was associated with less blood loss (148.2 vs. 195.0 ml, p = 0.022), and shorter length of hospital stay (9.5 vs. 12.2 days, p = 0.017), even during the learning period. With the accumulation of experience, the operative time decreased significantly from Phase 1 to Phase 2 (RTME, 360.6 vs. 323.5 min, p = 0.009; LTME, 338.1 vs. 301.9 min, p = 0.005), whereas other outcomes did not differ significantly. Conclusions Micro Hand S robot-assisted TME is safe and feasible even during the learning period, with outcomes comparable to laparoscopic surgery but superior in terms of blood loss, length of hospital stay, and learning curve. Trial registration Clinicaltrial.gov, NCT04836741, retrospectively registered on 5 April 2021.

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Section: Discussionsupporting

confidence: 92%

Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: a retrospective study

Wang

et al. 2021

BMC Gastroenterol

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“…Most studies’ primary aim was to define the learning curve, though for nine studies it was a secondary aim [ 26 , 27 , 29 – 31 , 42 , 43 , 46 , 59 ]. Thirteen studies reported on institutional learning curves [ 8 , 9 , 11 , 13 , 31 – 33 , 39 , 41 – 43 , 49 , 59 ], while the others reported on surgeons’ individual learning curves. Previous experience with colorectal surgery was mentioned in twenty-one studies [ 8 – 10 , 13 , 15 , 24 , 25 , 28 , 29 , 31 , 35 , 37 , 39 – 42 , 45 – 47 , 51 – 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies scored high on all criteria of the MINORS tool. Nineteen out of 41 non-comparative studies adequately reported more than half of the required criteria [ 9 – 12 , 15 , 24 , 25 , 27 , 33 , 35 , 37 , 38 , 48 – 50 , 53 , 55 ]. Study quality was highest among the TaTME studies, and varied most among the R-TME and L-TME studies.…”

Section: Resultsmentioning

confidence: 99%

“…One study prospectively calculated the study size [ 9 ] and seventeen used adequate statistical analyses [ 8 – 10 , 12 – 14 , 24 , 35 , 37 , 38 , 44 , 45 , 47 , 50 , 52 , 55 ]. Regarding the use of adequate definitions of clinical outcome variables, nineteen studies adequately reported unbiased assessment of endpoints [ 8 , 10 , 15 , 24 , 25 , 27 , 33 , 35 , 38 , 39 , 47 – 57 , 60 ] (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the use of adequate definitions of clinical outcome variables, nineteen studies adequately reported unbiased assessment of endpoints [ 8 , 10 , 15 , 24 , 25 , 27 , 33 , 35 , 38 , 39 , 47 – 57 , 60 ] (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review

et al. 2022

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Background The standard treatment of rectal carcinoma is surgical resection according to the total mesorectal excision principle, either by open, laparoscopic, robot-assisted or transanal technique. No clear consensus exists regarding the length of the learning curve for the minimal invasive techniques. This systematic review aims to provide an overview of the current literature regarding the learning curve of minimal invasive TME. Methods A systematic literature search was performed. PubMed, Embase and Cochrane Library were searched for studies with the primary or secondary aim to assess the learning curve of either laparoscopic, robot-assisted or transanal TME for rectal cancer. The primary outcome was length of the learning curve per minimal invasive technique. Descriptive statistics were used to present results and the MINORS tool was used to assess risk of bias. Results 45 studies, with 7562 patients, were included in this systematic review. Length of the learning curve based on intraoperative complications, postoperative complications, pathological outcomes, or a composite endpoint using a risk-adjusted CUSUM analysis was 50 procedures for the laparoscopic technique, 32–75 procedures for the robot-assisted technique and 36–54 procedures for the transanal technique. Due to the low quality of studies and a high level of heterogeneity a meta-analysis could not be performed. Heterogeneity was caused by patient-related factors, surgeon-related factors and differences in statistical methods. Conclusion Current high-quality literature regarding length of the learning curve of minimal invasive TME techniques is scarce. Available literature suggests equal lengths of the learning curves of laparoscopic, robot-assisted and transanal TME. Well-designed studies, using adequate statistical methods are required to properly assess the learning curve, while taking into account patient-related and surgeon-related factors.

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Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency

Burghgraef

Sikkenk

Crolla

et al. 2023

Int J Colorectal Dis

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Purpose Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision. Methods A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. Results In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve. Conclusion The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.

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Robotic sphincter saving rectal cancer surgery: A learning curve analysis

Cited by 10 publications

References 24 publications

Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: a retrospective study

Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: a retrospective study

The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review

Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency

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