Learning Curves in Robotic Rectal Cancer Surgery: A literature Review

Nasir, Muhammad Moiz; Panteleimonitis, Sofoklis; Ahmed, Jamil; Abbas, Hassan; Parvaiz, Amjad

doi:10.17795/minsurgery-41196

Cited by 5 publications

(4 citation statements)

References 31 publications

(49 reference statements)

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“…SPR-assisted surgery has been established, making it possible to perform robotic surgery with only one incision [ 21 22 23 ]. Research on the learning curve of surgery using robots has been reported, though studies on the learning curve of surgery using SPR have not been published [ 8 9 10 11 12 24 ]. In previous studies on robotic surgery, it has been suggested that the moving average line is useful in seeing the learning curve for managing OT.…”

Section: Discussionmentioning

confidence: 99%

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

Choi

Yun

et al. 2022

Ann Surg Treat Res

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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.

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Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, there is a growing interest in the recently introduced technique of SPR-assisted surgery. Although numerous studies on the learning curve of conventional robotic surgery have been published, few studies as of yet have investigated the learning curve of SPR-assisted rectal cancer surgery [ 8 9 10 11 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

Choi

Yun

et al. 2022

Ann Surg Treat Res

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“…In previous studies on colorectal surgery, the learning curve stabilized after 15 to 25 cases [17,18,21]. Thus, the SPR learning curve does not differ significantly from that for other surgical methods, including laparoscopic surgery [19,25]. In contrast, when single-incision laparoscopic surgery and conventional laparoscopic surgery are compared, the learning curve for single-incision laparoscopic surgery requires more cases [14].…”

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confidence: 86%

Learning curve for single-port robot-assisted colectomy

et al. 2024

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Purpose: Since the introduction of robotic surgery, robots for colorectal cancer have replaced laparoscopic surgery, and a single-port robot (SPR) platform has been launched and is being used to treat patients. We analyzed the learning curve and initial complications of using an SPR platform in colorectal cancer surgery. Methods: We reviewed 39 patients who underwent SPR colectomy from April 2019 to October 2019. All surgeries were performed by the same surgeon using an SPR device. A learning curve was generated using the cumulative sum methodology to assess changes in total operation time (OT), docking time (DT), and surgeon console time (SCT). We grouped the patients into 3 groups according to the time period: the first 11 were phase 1, the next 11 were phase 2, and the last 17 were phase 3. Results: The mean age of the patients was 61.28 ± 13.03 years, and they had a mean body mass index of 23.79 ± 2.86 kg/m 2 . Among the patients, 23 (59.0%) were male, and 16 (41.0%) were female. The average OT was 186.59 ± 51.30 minutes, the average SCT was 95.49 ± 35.33 minutes, and the average DT (time from skin incision to robot docking) was 14.87 ± 10.38 minutes. The SCT differed significantly among the different phases (P < 0.001). Complications occurred in 8 patients: 2 ileus, 2 postoperation hemoglobin changes, 3 urinary retentions, and 1 complicated fluid collection. Conclusion: In our experience, the learning curve for SPR colectomy was achieved after the 18th case.

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“…This approach offers a 3-dimentional view, superior dexterity and ergonomics, and a better identification of anatomical structures in the confined pelvis [45]. Another advantage may be a shorter learning curve (estimated 15–44 procedures) [46]. Compared to laparoscopy, 3 meta-analyses [47-49] showed similar oncological outcomes and postoperative morbidity associated with the robotic approach.…”

Section: Local Extension Of Rectal Adenocarcinoma At Diagnosismentioning

confidence: 99%

Current Surgical Strategies for the Treatment of Rectal Adenocarcinoma and the Risk of Local Recurrence

Longchamp

Meyer

Abbassi

et al. 2020

Dig Dis

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Background: Despite new medical and surgical strategies, 5-year local recurrence of rectal adenocarcinoma was reported in up to 25% of cases. Therefore, we aimed to review surgical strategies for the prevention of local recurrences in rectal cancer. Summary: After implementation of the total mesorectal excision (TME), surgical resection of rectal adenocarcinoma with anterior resection or abdominoperineal excision (APE) allowed decrease in local recurrence (3% at 5 years). More recently, extralevator APE was described as an alternative to APE, decreasing specimen perforation and recurrence rate. Moreover, technique modifications were developed to optimize rectal resection, such as the laparoscopic or robotic approach, and transanal TME. However, the technical advantages conferred by these techniques did not translate into a decreased recurrence rate. Lateral lymph node dissection is another technique, which aimed at improving the long-term outcomes; nevertheless, there is currently no evidence to recommend its routine use. Strategies to preserve the rectum are also emerging, such as local excision, and may be beneficial for subgroups of patients. Key Messages: Rectal cancer management requires a multidisciplinary approach, and surgical strategy should be tailored to patient factors: general health, previous perineal intervention, anatomy, preference, and tumor characteristics such as stage and localization.

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Learning Curves in Robotic Rectal Cancer Surgery: A literature Review

Cited by 5 publications

References 31 publications

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

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

Learning curve for single-port robot-assisted colectomy

Current Surgical Strategies for the Treatment of Rectal Adenocarcinoma and the Risk of Local Recurrence

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