Credentialing for robotic lobectomy: what is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon

Baldonado, Jobelle J.A.R.; Amaral, Marisa; Garrett, Joseph; Moodie, Carla; Robinson, Lary A.; Toloza, Eric M.; Fontaine, Jacques

doi:10.1007/s11701-018-00902-1

Cited by 21 publications

(12 citation statements)

References 10 publications

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“…However, no significant trend in the reduction in the RATS operative times, when comparing the first 10 with the last 10 cases, was observed in Worrell's series 32 . We calculated the learning curve regarding operation time from 13 articles, 24,32,33,49,59,66‐73 and the pooled data indicated that the operative time decreased significantly as the surgeon performed more surgeries (254.9 vs 198.7 min, WMD: 56.95, 95% CI:30.06‐83.83, P < .001; Supporting Information Figure S3). Therefore, it is possible that with the popularization of RATS, RATS would show a comparable operative time with VATS.…”

Section: Discussionmentioning

confidence: 97%

“…RATS had longer operative time than VATS and thoracotomy, and considering that RATS had not been widely applied in clinical practice and the sample size in most studies was small, the learning curve may contribute to this funding. Some studies suggested that the increase in operative time was due to the initial learning curve, 61,65 and others found a significant decrease in operative time comparing the first cases and the last cases 33,66,67 . However, no significant trend in the reduction in the RATS operative times, when comparing the first 10 with the last 10 cases, was observed in Worrell's series 32 .…”

Section: Discussionmentioning

confidence: 97%

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Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Chen

Dai

et al. 2020

Robotics Computer Surgery

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Background: The superiority of robot-assisted thoracic surgery (RATS) over videoassisted thoracic surgery (VATS) and thoracotomy remains controversial for lung cancer. Methods: A network meta-analysis (NMA) and pairwise meta-analysis (PMA) were performed to evaluate the perioperative outcomes using five databases. Results: Thirty-two studies involving 6593 patients were included for analysis. The NMA showed that RATS had similar operative time, conversion rate to thoracotomy, number of lymph node, postoperative morbidity, and length of hospital stay with VATS, except for lower 30-day mortality. Compared with thoracotomy, longer operative time and shorter hospital stay were observed in RATS, but no significant difference was observed in number of lymph node, postoperative morbidity, and 30-day mortality in both NMA and PMA. In lobectomy/segmentectomy subgroup, all outcomes, except for operative time of RATS vs VATS and number of lymph node, were similar with overall analyses. Conclusions: RATS had comparable perioperative outcomes with VATS and open surgery.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Chen

Dai

et al. 2020

Robotics Computer Surgery

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“…[ 11 , 13 , 16 ] On the other hand, for surgeons who have an extensive experience in performing lobectomy with VATS, the learning curve may be easier to move from VATS to robotic technique. [ 18 ] As reported by Baldonado et al,[ 18 ] the learning curve of RATS by a surgeon having prior VATS experience showed no particular change point with a continuous improvement. Although various indicators including complication rates, conversion rates, OTs, and oncological outcomes are used to assess the learning curve, this study measured OTs and investigated whether the learning curve based on OT of a single surgeon was correlated with the experience in performing VATS and RATS, if there was a correlation between the learning curve and the skill of the surgeon.…”

Section: Discussionmentioning

confidence: 78%

Effects of robot- and video-assisted thoracoscopic lobectomy experiences on the learning curve of lobectomy

Kanzaki¹,

Mitsuboshi²,

Koen³

et al. 2021

Turk Gogus Kalp Dama

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Background: This study aims to investigate the effects of robot- and videoassisted thoracoscopic lobectomy on the learning curve of lobectomy. Methods: Between September 2013 and February 2020, the first 68 consecutive patients (28 males, 40 females; median age: 71 years; range, 33 to 86 years) who were operated for lung malignancies and scheduled for robot-assisted thoracoscopic lobectomy were retrospectively analyzed. The characteristics of the patients and operative data were analyzed, and the operation times of the first 51 cases of video-assisted thoracoscopic lobectomy were compared with those of robot-assisted thoracoscopic lobectomy performed by a single surgeon. Results: Of the patients, 62 had primary lung cancer and six had metastatic lung tumors. The majority of primary lung cancer patients (87.1%) had an adenocarcinoma. The most common clinical stage was IA1 (30.9%). There was no emergent conversion to thoracotomy in any of the patients. The median operation time was 223.5 min, and console time was 151 min. The most common complication was an air leak. All patients were alive. Compared to video-assisted thoracoscopic lobectomy, the median operation time was significantly longer in the robot-assisted thoracoscopic lobectomy group (p=0.0002). Similar to the operation time learning curve of the video-assisted thoracoscopic surgery group, the operation time learning curve of the robotassisted thoracoscopic surgery group increased from the first to ninth case (Phase 1), plateaued from the 10th t o 14th c ase ( Phase 2 ), and decreased from the 15th case (Phase 3). There was a statistically significant decrease in the operation time between Phase 1 and Phase 3 (p=0.0063). Conclusion: The results of robot-assisted thoracoscopic lobectomy by a single surgeon show that this surgery has a longer operation time, but the perioperative outcomes are satisfactory. The learning curve of this surgery may be gradual for experienced video-assisted thoracoscopic surgeons.

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“…Estimates of a numeric learning curve vary widely (reports diverge from 15 to 200 cases for robotic lobectomy) and is dependent on case complexity and the prior experience of the surgeon. Reviewing robotic lobectomy in a single-surgeon series, for example, Baldonado and colleagues reported steady reductions in operative time, blood loss, chest tube duration, overall hospital stay and decreased rate of complications with increasing cumulative operative experience (3). There were a total of 6 vascular injuries, all of which occurred in an early cohort of cases.…”

Section: The Robotic Learning Curvementioning

confidence: 99%

Beyond the learning curve: a review of complex cases in robotic thoracic surgery

Geraci¹,

Scheinerman²,

Chen³

et al. 2021

J Thorac Dis

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The number of thoracic surgery cases performed on the robotic platform has increased steadily over the last two decades. An increasing number of surgeons are training on the robotic system, which like any new technique or technology, has a progressive learning curve. Central to establishing a successful robotic program is the development of a dedicated thoracic robotic team that involves anesthesiologists, nurses, and bed-side assistants. With an additional surgeon console, the robot is an excellent platform for teaching. Compared to current methods of video-assisted thoracoscopic surgery (VATS), the robot offers improved wristed motion, a magnified, high definition three-dimensional vision, and greater surgeon control of the operation. These advantages are paired with integrated adjunctive technology such as infrared imaging. For pulmonary resection, these advantages of the robotic platform have translated into several clinical benefits, such as fewer overall complications, reduced pain, shorter length of stay, better postoperative pulmonary function, lower operative blood loss, and a lower 30-day mortality rate compared to open thoracotomy. With increased experience, cases of greater complexity are being performed. This review article details the process of becoming an experienced robotic thoracic surgeon and discusses a series of challenging cases in robotic thoracic surgery that a surgeon may encounter "beyond the learning curve". Nearly all thoracic surgery can now be approached robotically, including sleeve lobectomy, pneumonectomy, resection of large pulmonary and mediastinal masses, decortication, thoracic duct ligation, rib resection, and pulmonary resection after prior chest surgery and/or chemoradiation.

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Credentialing for robotic lobectomy: what is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon

Cited by 21 publications

References 10 publications

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

Effects of robot- and video-assisted thoracoscopic lobectomy experiences on the learning curve of lobectomy

Beyond the learning curve: a review of complex cases in robotic thoracic surgery

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