The Learning Curve Study of Robotic Distal Gastrectomy: an Analysis of Outcomes of the First 67 Consecutive Cases at a High-Volume Gastric Center

Shen, Jiliang; Feng, Xiao; Wang, Yong

doi:10.1007/s11605-022-05498-4

Cited by 4 publications

(4 citation statements)

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“…However, robotic gastrectomy was initiated in April 2020 and is associated with a learning curve. Our previous study ( 15 ) concluded that Professor Wang’s skills in robotic gastrectomy attained a stable phase after executing 35 cases. Hence, we inferred that surgical outcomes in the two robotic subgroups - namely, the promotion phase and the stable phase of the learning curve - would differ.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, laparoscopic gastrectomy had already been performed for more than a decade before this period. Owing to the limited number of robotic surgical cases, robotic distal gastrectomy cases were further divided into an early experience group and a late experience group according to the learning curve, which was also reported in our previous study ( 15 ). Lastly, these two subgroups were individually compared with the laparoscopic group in order to reach more credible conclusions.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of short-term outcomes between robotic and laparoscopic distal gastrectomy performed by the same surgical team during the same period

Shen

et al. 2023

Front. Oncol.

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ObjectiveTo evaluate the short-term outcomes of laparoscopic distal gastrectomy and robotic distal gastrectomy performed during the same period.MethodsThis study enrolled 46 cases of laparoscopic distal gastrectomy and 67 cases of robotic distal gastrectomy that were performed by a single surgeon between April 2020 to October 2021. Baseline characteristics and short-term outcomes of these two groups were then compared. Moreover, the robotic distal gastrectomy group was further divided into two subgroups according to the learning curve. Finally, the baseline characteristics and short-term outcomes of both subgroups were compared with the laparoscopic group, respectively.ResultsThe baseline characteristics and short-term outcomes of the LDG group and RDG group were comparable. In contrast, the operation time in the laparoscopic group was significantly shorter than that in the early experience robotic group (191.3 ± 37.6 VS 225.1 ± 49, P=0.001). However, the operation time (191.3 ± 37.6 VS 185.3 ± 25.3, P=0.434) was comparable between the laparoscopic group and the late experience robotic group. Likewise, the bleeding volume was comparable between the laparoscopic and early experience robotic groups. However, bleeding volume was significantly lower in the late experience robotic group compared to that in the laparoscopic group (37.5 ± 18.8 VS 49.2 ± 29.0, P=0.049).ConclusionsWith surgeons stepping into the stable stage of the robotic learning curve, RDG showed a comparable operation time and lower volume of blood loss compared with LDG. Collectively, our study supports the application of robotic distal gastrectomy in patients diagnosed with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of short-term outcomes between robotic and laparoscopic distal gastrectomy performed by the same surgical team during the same period

Shen

et al. 2023

Front. Oncol.

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“…Since then, it has become our operative approach of choice for a wide range of simple to very complex procedures, such as hernia repairs, esophagectomies, liver resections, distal pancreatectomies, and pancreaticoduodenectomies; [9][10][11][12] this also includes gastrectomies, which in our experience and from the experience of others, has a relatively moderate learning curve. 13 This study aimed to compare our patients undergoing robotic gastrectomy to those patients in NSQIP to establish if our patient are similar to those in NSQIP, to compare our patients' outcome in NSQIP to those predicted by NSQIP risk calculator, and to compare our outcome to those predicted by the American College of Surgeons (ACS) NSQIP Surgical Risk Calculator. Our hypothesis in undertaking this study was that robotic gastrectomy provides salutary outcomes and optimal survival for patients undergoing this robotic gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of NSQIP National Outcomes and Projected Outcomes versus Our Institutional Outcomes for Robotic Gastrectomy: The Future of Gastric Resection

Ross

Slavin

Sucandy

et al. 2023

The American Surgeon™

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Background The robotic approach has vast applications in surgery; however, the utility of robotic gastrectomy has yet to be clearly defined. This study aimed to compare outcomes following robotic gastrectomy at our institution to the national patient-specific predicted outcomes data provided by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Methods We prospectively studied 73 patients who underwent robotic gastrectomy under our care. ACS NSQIP outcomes after gastrectomy and predicted outcomes for our patients were compared with our actual outcomes utilizing students t test and chi-square analysis, where applicable. Data are presented as median (mean ± SD). Results Patients were 65 (66 ± 10.7) years old with a BMI of 26 (28 ± 6.5) kg/m2. 35 patients had gastric adenocarcinomas and 22 had gastrointestinal stromal tumors Operative duration was 245 (250 ± 114.7) minutes, estimated blood loss was 50 (83 ± 91.6) mL, and there were no conversions to ‘open’. 1% of patients experienced superficial surgical site infections compared to the NSQIP predicted rate of 10% ( P < .05). Length of stay (LOS) was 5 (6 ± 4.2) days vs NSQIP’s predicted LOS of 8 (8 ± 3.2) days ( P < .05). Three patients died during their postoperative hospital course (4%), due to multi-system organ failure and cardiac arrest. 1-year, 3-year, and 5-year estimated survival for patients with gastric adenocarcinoma was 76%, 63%, and 63%, respectively. Discussion Robotic gastrectomy yields salutary patient outcomes and optimal survival for varying gastric diseases, particularly gastric adenocarcinoma. Our patients experienced shorter hospital stays and reduced complications relative to patients in NSQIP and predicted outcome for our patients. Gastrectomy undertaken robotically is the future of gastric resection.

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Proficiency in bariatric surgery may shorten the learning curve for minimally-invasive D2 gastrectomy

Flemming,

Kollmann,

Widder

et al. 2024

Langenbecks Arch Surg

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Introduction Evidence from Asian studies suggests that minimally-invasive gastrectomy achieves equivalent oncological but improved perioperative outcomes compared to open surgery. Oncological gastric resections are less frequent in European countries. Index procedures may play a role for the learning curve of minimally-invasive gastrectomy. The aim of our study was to evaluate if skills acquired in bariatric surgery allow a safe and oncologically adequate implementation of minimally-invasive gastrectomy in a cohort of european patients. Methods In this single-center retrospective study, all patients who received primary bariatric surgery between January 2015 and December 2018 and minimally-invasive surgery for gastric cancer treated from June 2019 to January 2023 were evaluated. Primary endpoints were operation time, lymph node yield and lymph node fractions. Secondary endpoints included postoperative complications and oncological outcomes. Results Learning curves for two surgeons with 350 bariatric procedures and 44 minimally-invasive gastrectomies were analyzed. For bariatric surgery, the mean operation time decreased from initially 82 ± 27 to 45 ± 21 min and 118 ± 28 to 81 ± 36 min for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), while the complication rate remained within the international benchmark. For laparoscopic gastrectomy (n = 30), operation times decreased but then remained stable over time. Operation times for the robotic platform were longer (302 ± 60 vs. 390 ± 48 min; p < 0.001) with the learning curve remaining incomplete after 14 procedures. R0 status was achieved in 95.5% of patients; the mean number of lymph nodes retrieved was 37 ± 14 with no differences between the groups. Complete mesogastric excision was more frequently achieved during the later laparoscopic cases whereas it occurred earlier for the robotic group (p = 0.004). Perioperative morbidity was comparable to the European benchmark. Textbook outcome was achieved in 54.4% of the cases. Conclusion In summary, we could demonstrate a successful skill transfer from bariatric surgery to minimally-invasive laparoscopic oncological gastric surgery enabling safe and oncologically adequate minimally-invasive D2 gastrectomy in a central European patient collective.

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The Learning Curve Study of Robotic Distal Gastrectomy: an Analysis of Outcomes of the First 67 Consecutive Cases at a High-Volume Gastric Center

Cited by 4 publications

References 4 publications

Comparison of short-term outcomes between robotic and laparoscopic distal gastrectomy performed by the same surgical team during the same period

Comparison of short-term outcomes between robotic and laparoscopic distal gastrectomy performed by the same surgical team during the same period

Comparative Analysis of NSQIP National Outcomes and Projected Outcomes versus Our Institutional Outcomes for Robotic Gastrectomy: The Future of Gastric Resection

Proficiency in bariatric surgery may shorten the learning curve for minimally-invasive D2 gastrectomy

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