Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy.

Abstract

OBJECTIVE:

To evaluate the complication-based learning curve and identify learning-associated complications of robotic gastrectomy.

SUMMARY BACKGROUND DATA:

With the increased popularity of robotic surgery, a sound understanding of the learning curve in the surgical outcome of robotic surgery has taken on great importance. However, a multicenter prospective study analyzing learning-associated morbidity has never been conducted in robotic gastrectomy.

METHODS:

Data on 502 robotic gastrectomy cases were prospectively collected from 5 surgeons. Risk-adjusted cumulative sum analysis was applied to visualize the learning curve of robotic gastrectomy on operation time and complications.

RESULTS:

Twenty-five cases, on average, were needed to overcome complications and operation time-learning curve sufficiently to gain proficiency in 3 surgeons. An additional 23 cases were needed to cross the transitional phase to progress from proficiency to mastery. The moderate complication rate (CD ≥ grade II) was 20% in phase 1 (cases 1-25), 10% in phase 2 (cases 26-65), 26.1% in phase 3 (cases 66-88), and 6.4% in phase 4 (cases 89-125) (P < 0.001). Among diverse complications, CD ≥ grade II intra-abdominal bleeding (P < 0.001) and abdominal pain (P = 0.01) were identified as major learning-associated morbidities of robotic gastrectomy. Previous experience on laparoscopic surgery and mode of training influenced progression in the learning curve.

CONCLUSIONS:

This is the first study suggesting that technical immaturity substantially affects the surgical outcomes of robotic gastrectomy and that robotic gastrectomy is a complex procedure with a significant learning curve that has implications for physician training and credentialing.

• Authors: Min Seo Kim, Won Jun Kim, Woo Jin Hyung, Hyoung-Il Kim, Sang-Uk Han, Young-Woo Kim, Keun Won Ryu, Sungsoo Park
• Journal: Annals of surgery (Ann Surg) Vol. 273 Issue 5 Pg. 949-956 (05 01 2021) ISSN: 1528-1140 [Electronic] United States
• PMID: 31503017 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Education, Medical, Graduate (methods)
• Gastrectomy (education, methods)
• Humans
• Laparoscopy (education, methods)
• Learning Curve
• Operative Time
• Prospective Studies
• Robotic Surgical Procedures (education, methods)
• Stomach Neoplasms (surgery)
• Surgeons (education)