Learning curve for single-port robot-assisted rectal cancer surgery

Abstract

Purpose We analyzed the learning curve of single-port robotic (SPR)-assisted rectal cancer surgery. Methods Fifty-seven consecutive SPR-assisted rectal cancer surgery cases performed by the same surgeon were considered in surgical interventions for rectal cancer. Total operation time (OT), docking time (DT), and surgeon console time (SCT) measured during surgery were used to parametrize the learning curve. The parameters representing the learning curve were evaluated using the cumulative sum (CUSUM). Results The mean value of total OT was 241.8 ± 91.7 minutes, the mean value of DT was 20.6 ± 19.1 minutes, and the mean value of SCT was 135.9 ± 66.7 minutes. The learning curve was divided into phase 1 (initial 16 cases), phase 2 (second 16 cases), and phase 3 (subsequent 25 cases). The peak on the CUSUM graph occurred in the 21st case. The longest OT among phases was in phase 2. Complications were most frequent in phase 2. However, complications of Clavien-Dindo (CD) grade IIIb were most frequent in phase 3 with 2 patients. The most common complications were fluid collection and urinary retention (7 patients each). Complications of CD grade IIIb required one stomal revision due to stoma obstruction and one irrigation and loop ileostomy due to anastomosis leakage. Conclusion Improvement in surgical performance of SPR assisted rectal cancer operation was achieved after 21 cases. The three phases identified in the cumulative sum analysis showed a significant decrease in operative time after the middle stage of the learning curve without an increase in the complication rate.

Single‐port laparoscopic versus single‐port robotic right hemicolectomy: Postoperative short‐term outcomes

“…Therefore, the large difference in operation time shown in this study is thought to be due to the lack of experience in robotic surgery and the lack of an established SPR right hemicolectomy protocol, which took time to establish new settings. Choi et al 22 . studied the learning curve for a total of 57 SPR rectal cancer surgeries by the same surgeon as ours and found out that an improvement in the surgical performance of SPR rectal cancer surgery was achieved after 21 cases 22 .…”

“…improvement in the surgical performance of SPR rectal cancer surgery was achieved after 21 cases. 22 Although no study has been conducted on the learning curve for SPR right hemicolectomy, a pattern similar to that of SPR rectal cancer surgery can be expected and the difference in time between the two groups may decrease.…”

Learning curve for uniportal thoracoscopic pulmonary segmentectomy: how many procedures are required to acquire expertise?

“…CUSUM allows rapid and powerful assessment of changes in means or slopes of trends for data collected at regular intervals. CUSUM has previously been used to evaluate the learning curves for robotic-assisted and laparoscopic surgeries ( 18 , 19 ). In the present study, we assessed the learning curve for uniportal thoracoscopic segmentectomy using the CUSUM technique, for individual surgeons and teams, in terms of the number of cases required to acquire expertise.…”

A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

“…Postoperative morbidity (n, %) Previous work was published on proficiency with SP rColectomy and rectal cancer cases, using the procedure and docking times as the key metric [48,49]. Using a cusum curve, the authors predicted the optimal stabilization was 18 colectomy and 21 rectal cancer cases.…”