The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon’s Experience While Introducing the Robotic Technology in a Bariatric Surgery Department

Abstract

Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases.

An appraisal of the learning curve in robotic general surgery

“…Origin: The studies originated from 12 countries; 8 were from the USA [7][8][9][10][11][12][13][14] and 6 from South Korea [15][16][17][18][19][20] with the remainder from a variety of European [21][22][23][24][25][26][27][28] and Asian countries [29][30][31][32].…”

“…Eight studies focused on foregut surgery: 3 studies on gastrectomy [15,19,32], 2 each on gastro-esophageal surgery [10,22] and Rouxen-Y gastric bypass (bariatric) surgery [21,27], and 1 on sleeve gastrectomy [28]. Five studies investigated the use of the robot in biliary surgery [7,11,12,14,26].…”

“…Regression or moving average analysis was also employed by 5 studies each; on occasion in combination with CUSUM or each other [10,14,15,18,19,26,27,30]. The remaining studies used analysis of variance (ANOVA) [7], a mixed effect model [12], or least square estimation [28]. Table 2 shows the parameters and statistical methods used to determine the learning curve.…”

“…Ten studies identified a single inflection point around which performance significantly changed, suggesting a bi-phasic learning curve [7,10,15,17,19,21,25,27,28,30]. Eight studies identified two inflection points around which performance significantly changed, suggesting a tri-or multi-phasic learning curve [8,11,13,20,24,29,31,32].…”

“…Foregut Surgery: The initial learning phase in foregut surgery is overcome after between 8 and 95 cases [10,15,19,21,22,27,28,32]. Even at a more procedurespecific level, the number of cases needed to overcome the learning curve is quite variable.…”