Learning Curve of Robotic Rectal Surgery With Lateral Lymph Node Dissection: Cumulative Sum and Multiple Regression...

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Colorectal Surgery

Background:

• Robotic rectal surgery is gaining traction due to potential advantages over laparoscopic approaches.
• The learning curve for robotic rectal surgery, particularly with lateral lymph node dissection, remains under-assessed.
• Advanced robotic systems are hypothesized to shorten the learning curve compared to traditional methods.

Purpose of the Study:

• To evaluate the learning curve associated with robotic rectal surgery performed by a single surgeon.
• To identify factors influencing the learning curve, specifically console time.
• To determine the number of cases required to achieve proficiency in robotic rectal surgery.

Main Methods:

• A retrospective analysis of 131 consecutive patients undergoing robotic rectal or sigmoid colon surgery.
• Cumulative sum (CUSUM) analysis and multiple linear regression were used to assess console time.
• Data were collected from February 2012 to July 2016 at a single institution.

Main Results:

• The learning curve was divided into three phases: Cases 1-19 (Phase I), 20-78 (Phase II), and 79-131 (Phase III).
• Significant reductions in console time were observed between phases (Phase I-II: 83.0 min; Phase II-III: 40.1 min).
• Lateral lymph node dissection added an average of 138.4 minutes to console time; BMI and procedure type also impacted time, but neoadjuvant therapy and invasion depth did not.

Conclusions:

• The initial 19 cases represent a critical learning phase for mastering robotic arm manipulation and spatial orientation.
• Robotic rectal surgery demonstrates a defined learning curve, with proficiency achievable within the first 19 cases.
• The findings support the feasibility of robotic rectal surgery, with specific considerations for complex procedures like lateral lymph node dissection.