The robotic learning curve for a newly appointed colorectal surgeon

Saqib, Sabah Uddin; Raza, Muhammad Zeeshan; Evans, Charles; Bajwa, Adeel

doi:10.1007/s11701-022-01400-1

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Finally, we contribute objective data on learning curves for robotic fundoplication, utilising a novel method of regression-based casemix adjustment of CUSUM calculation, which may serve to benchmark future studies. There is a dearth of guidance for the adoption of robotic upper gastro-intestinal surgery [ 12 ], with only nascent efforts being developed in other specialties such as colorectal surgery and urology [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

et al. 2023

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Background The adoption of new surgical technologies is inevitably accompanied by a learning curve. With the increasing adoption of robotic techniques in benign foregut surgery, it is imperative to define optimal learning pathways, to ensure a clinically safe introduction of such a technique. The aim of this study was to assess the learning curve for robotic hiatal hernia repair with a pre-defined adoption process and proctoring. Methods The learning curve was assessed in four surgeons in a high-volume tertiary referral centre, performing over a 100 hiatal hernia repairs annually. The robotic adoption process included simulation-based training and a multi-day wet lab-based course, followed by robotic operations proctored by robotic upper GI experts. CUSUM analysis was performed to assess changes in operating time in sequential cases. Results Each surgeon (A, B, C and D) performed between 22 and 32 cases, including a total of 109 patients. Overall, 40 cases were identified as ‘complex’ (36.7%), including 16 revisional cases (16/109, 14.7%). With CUSUM analysis inflection points for operating time were seen after 7 (surgeon B) to 15 cases (surgeon B). Conclusion The learning curve for robotic laparoscopic fundoplication may be as little as 7–15 cases in the setting of a clearly organized learning pathway with proctoring. By integrating these organized learning pathways learning curves may be shortened, ensuring patient safety, preventing detrimental outcomes due to longer learning curves, and accelerating adoption and integration of novel surgical techniques.

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Section: Discussionmentioning

confidence: 99%

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

et al. 2023

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“…There is also a learning curve and specialist knowledge that make this operation only appropriate in high volume specialist units. Saqib et al suggested that a proficient laparoscopic surgeon started to plateau in the learning curve after 30 proctored cases [18]. When considering future directions, one concedes that robotic operations are currently longer and more expensive.…”

Section: Ta B L E 5 Reversal Of Ileostomymentioning

confidence: 99%

An early experience in robotic ileoanal pouch surgery with robotic intracorporeal single‐stapled anastomosis (RiSSA) at a tertiary referral centre

et al. 2023

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Aim A robotic approach to ileal pouch–anal anastomosis (IPAA) surgery offers advantages over other approaches in terms of precision, improved access to the pelvis and less muscular fatigue for the surgeon. The integrity of the anastomosis is also fundamental to successful IPAA surgery. The robotic platform can permit intracorporeal suturing deep within the pelvis to create a single‐stapled, double purse‐string anastomosis, which may reduce the risk of anastomotic complications. This study describes the safety and early outcomes of robotic intracorporeal single‐stapled anastomosis (RiSSA) amongst patients operated consecutively at a tertiary centre immediately before and following the pandemic. Method A retrospective study of prospectively collected data analysing the outcome of patients undergoing robotic IPAA between 2019 and 2022 was conducted. All procedures were performed with the da Vinci Xi Surgical System (with a hand‐assisted suprapubic incision to fashion the pouch). All pouch–anal anastomoses were performed using a double purse‐string, single‐stapled (RiSSA) method. Demographic, clinical and outcome data were collected. Results Twenty consecutive patients (nine with ulcerative colitis and 11 with familial adenomatous polyposis) were included with a median age of 25 years (range 16–52); 18 had American Society of Anesthesiologists classification II, and mean body mass index was 24 kg/m2 (range 18.1–34.3). Nine patients (eight ulcerative colitis and one familial adenomatous polyposis) had undergone prior subtotal colectomy and therefore underwent restorative proctectomy with IPAA. Eleven patients underwent restorative proctocolectomy. All procedures were completed robotically. The median length of stay was 9 days (5–49). There were no unplanned admissions to intensive care and no deaths. Three patients were readmitted following hospital discharge for (i) an ileus managed conservatively, (ii) small bowel obstruction managed conservatively and (iii) small bowel obstruction due to constriction at the stoma site necessitating surgery. There were two additional reoperations both for drain complications, one for drain removal and one for drain erosion. On mobilization of the pouch in the latter case, an anastomotic defect was observed. In total, 19/20 patients underwent RiSSA without postoperative anastomotic problems. Discussion RiSSA offers a safe and feasible alternative technique to other minimally invasive approaches with low rates of anastomosis‐related complications.

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“…Most of the robotic instruments are designed with seven degrees of freedom (insertion, external pitch, external yaw, rotation, wristed pitch, wristed yaw, and grasp). This feature makes robotic colorectal surgery unique as compared to laparoscopic colorectal surgery as this may lower the learning curve for colorectal surgeons and allows them to do complex pelvic dissection which is not possible laparoscopically 11 . The endo wrist instruments are designed to mimic the dexterity of the human wrist.…”

Section: Controls Awareness Exercises For Robotic Colorectal Surgerymentioning

confidence: 99%

The role of Da Vinci Xi robotic simulation curriculum in enhancing skills in robotic colorectal surgery

Saqib,

Bajwa

2023

Annals of Medicine &Amp; Surgery

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Robotic surgery in comparison to open and laparoscopic surgery allows better ergonomics, three-dimensional vision, and seven-degree freedom of movement. This ensures fast recovery, fewer postoperative complications, and safe oncological resections. Robotic surgery has revolutionized the field of colorectal surgery, providing surgeons with enhanced precision, dexterity, and visualization. To ensure safe and successful outcomes, surgeons must acquire competency and proficiency in robotic surgical techniques. Robotic simulation exercises have emerged as a valuable tool for training and skill development in robotic colorectal surgery. This research paper explores the importance and relationship between robotic simulation exercises and the acquisition of skills and competency required for carrying out safe colorectal surgery using a robotic platform. The authors discuss the benefits of virtual simulation-based training using the Da Vinci Xi skill simulator, and the evidence supporting its effectiveness in colorectal surgery. In this article, emphasis has been made on some important Da Vinci Xi skill simulator exercises for enhancing skills in robotic colorectal surgery.

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The robotic learning curve for a newly appointed colorectal surgeon

Cited by 6 publications

References 20 publications

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

An early experience in robotic ileoanal pouch surgery with robotic intracorporeal single‐stapled anastomosis (RiSSA) at a tertiary referral centre

The role of Da Vinci Xi robotic simulation curriculum in enhancing skills in robotic colorectal surgery

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