Learning Curve for Robot-Assisted Minimally Invasive Thoracoscopic Esophagectomy: Results From 312 Cases

Sluis, Pieter C. van der; Ruurda, Jelle P.; Horst, Sylvia van der; Goense, Lucas; Hillegersberg, Richard van

doi:10.1016/j.athoracsur.2018.01.038

Cited by 122 publications

(81 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, it was reported that RAMIE can safely be performed with the patient in semiprone position (26), which can reduce the incidence of postoperative pulmonary complications (27). The duration of the learning curve for RAMIE has been reported to take 20-70 cases (28)(29)(30). One study found that the use of a structured training pathway that involved proctoring reduced the learning curve for RAMIE from 70 to 24 cases (30).…”

Section: Ramie Vs Open Esophagectomymentioning

confidence: 99%

“…The duration of the learning curve for RAMIE has been reported to take 20-70 cases (28)(29)(30). One study found that the use of a structured training pathway that involved proctoring reduced the learning curve for RAMIE from 70 to 24 cases (30). In light of the increasing centralization of care, this seems to be a feasible number of cases in order to complete the learning curve within an acceptable time frame.…”

Section: Ramie Vs Open Esophagectomymentioning

confidence: 99%

See 1 more Smart Citation

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

et al. 2019

Self Cite

View full text Add to dashboard Cite

Robotic assisted minimal invasive esophagectomy (RAMIE) is increasingly applied as a clinically and oncologically safe technique in the surgical treatment of esophageal cancer. This review focuses on the advantages and potential opportunities of RAMIE to improve the perioperative and oncological outcomes based on the evidence from current literature. In addition, critical notes on aspects such as procedure duration and costs are addressed in this paper.

show abstract

Section: Ramie Vs Open Esophagectomymentioning

confidence: 99%

Section: Ramie Vs Open Esophagectomymentioning

confidence: 99%

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…It was considered that the CAS-LCWHTOs were performed with greater CAS experience obviously after completion of the learning curve for CAS compared with the cases performed before the learning curve completion. Because the learning curve for CAS-LCWHTO is not well defined, we referred to the previously reported learning curve for CAS in various fields; the learning curves for CAS were completed in 20-70 cases [16,17]. In the present study, it was determined that 70 cases would be required to complete the learning curve for CAS-LCWHTO.…”

Section: Patientsmentioning

confidence: 99%

The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy

Lee

Song

Bae³

et al. 2019

Knee Surg & Relat Res

View full text Add to dashboard Cite

Background: There is debate regarding the influence of a surgeon's experience with computer-assisted surgery (CAS) on the postoperative mechanical axis (MA) in CAS-high tibial osteotomy. The purpose of the present study was to compare radiographic results between early and late cohorts of a consecutive series of patients to assess the influence of CAS experience on accuracy and precision of the postoperative MA during CAS lateral closingwedge high tibial osteotomy (LCWHTO). Materials and methods: Results from 140 CAS-LCWHTO operations were retrospectively reviewed. The first 70 cases, performed during the learning curve period for CAS between 2005 and 2009, were considered to be the "early cohort." The subsequent 70 cases, performed with greater CAS experience after the completion of the learning curve between 2009 and 2014, were considered to be the "late cohort." The target postoperative MA angle was valgus 3°. Pre-and postoperative MA angles were evaluated by navigation and radiographs. The proportion of postoperative MA inliers (≤ target angle ±3°) was investigated radiographically. The correlation between the navigation and radiographic measurements was analyzed. Results: The average postosteotomy MA angle on navigation was 3.4°in both cohorts. The average postoperative MA angle on radiographs was 1.0°in the early cohort and 2.2°in the late cohort (P = 0.003). Radiographically, the proportion of postoperative MA inliers was greater in the late cohort than in the early cohort (early versus late, 71.4% versus 90%; P = 0.011). The pre-and postoperative correlation between navigation and radiographic measurements was also stronger in the late cohort (early versus late; preoperative r = 0.558 versus 0.663; postoperative r = 0.310 versus 0.376). Conclusions: Greater experience with CAS increased the accuracy and precision of postoperative MA alignment as well as the correlation between navigation and radiographic measurements. Caution should be taken during registration procedures to achieve accurate alignment correction in CAS-LCWHTO.

show abstract

“…This means that a substantial part of the included patients in the RAMIE group underwent surgery during the learning phase, as a previous study indicates that the learning curve for RAMIE takes up to 70 cases to complete. 19 Intraoperative blood loss and operating time are known to decrease with increasing experience, which might imply that the reported longer duration of surgery in the RAMIE group might not be present anymore and that even less intraoperative blood loss might be observed after completion of the learning curve. However, to adequately investigate such outcomes, studies on larger case series of patients who undergo RAMIE after completion of the surgeon's learning curve are warranted.…”

mentioning

confidence: 98%

“…A recent study reported that the learning curve of RAMIE can be decreased from 70 to 24 cases when adhering to a structured training pathway, which successively involves a robotic cadaver course, case observations, and proctoring by an experienced peer. 19 By shortening the learning curve of RAMIE, structured training pathways likely increase the safety and efficacy of the implementation phase. The facilitation and promotion of such structured training pathways in one of the key aims of the 'Upper GI International Robotic Association (UGIRA)', which was established in 2017 and serves as an important platform to connect surgeons who are willing to implement RAMIE (and other robot-assisted esophagogastric techniques) to proctors worldwide.…”

mentioning

confidence: 99%

Comment on: “Early Outcomes of Robot-Assisted Versus Thoracoscopic-Assisted Ivor Lewis Esophagectomy for Esophageal Cancer: A Propensity Score-Matched Study”

Kingma

Ruurda

2019

Ann Surg Oncol

Self Cite

View full text Add to dashboard Cite

Zhang and colleagues are to be complimented for recently conducting an interesting study that compared the perioperative outcomes of two-stage robot-assisted minimally invasive esophagectomy (RAMIE) versus two-stage conventional minimally invasive esophagectomy (MIE). 1 In that study, it was concluded that RAMIE and MIE are similar regarding intraoperative blood loss, postoperative complications, length of hospital stay, and lymph node yield; however, the operating time was significantly longer in the RAMIE group. These findings are a valuable addition to the existing evidence for RAMIE and we would like to place this into a broader perspective. Although open esophagectomy is still the worldwide standard, MIE is increasingly applied, aiming to decrease surgical trauma and ultimately improve postoperative outcomes in terms of postoperative complications. This paradigm shift is largely based on evidence from case series and a randomized controlled trial, which indicated that MIE may be superior to open esophagectomy in terms of intraoperative blood loss, postoperative pulmonary complications, length of hospital stay, and quality of life. 2 However, several recent population-based studies have reported a higher re-intervention rate in patients who underwent MIE, while no evident reduction in postoperative pulmonary complications or overall morbidity was observed. 3-6 It was postulated that these findings might be explained by the learning curve of MIE as the early adaptation phase was within the inclusion years for most

show abstract

Learning Curve for Robot-Assisted Minimally Invasive Thoracoscopic Esophagectomy: Results From 312 Cases

Abstract: The learning phase of thoracic laparoscopic RAMIE consisted of 70 procedures in 55 months. A structured proctoring for RAMIE substantially reduced the number of procedures and time required to achieve proficiency.

Cited by 122 publications

References 24 publications

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy

Comment on: “Early Outcomes of Robot-Assisted Versus Thoracoscopic-Assisted Ivor Lewis Esophagectomy for Esophageal Cancer: A Propensity Score-Matched Study”

Contact Info

Product

Resources

About