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Learning curve in robotic colorectal surgery.

Yosef Nasseri1,2, Isabella Stettler3,4, Wesley Shen3,4

  • 1Cedars Sinai Medical Center, 8635 W 3rd St #880, Los Angeles, CA, 90048, USA. yosefnasseri@gmail.com.

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This study establishes a three-phase learning curve for robotic colorectal surgery, identifying distinct periods of learning, competence, and mastery. Findings aid in training and credentialing new robotic surgeons.

Keywords:
ColorectalCumulative sum analysisLearning curveRobotic surgery

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Robotics
  • Colorectal Surgery

Background:

  • Robotic adoption in colorectal surgery necessitates understanding surgeon learning curves for competency assessment.
  • Evaluating the learning curve is crucial for self-assessment and credentialing of surgeons transitioning to robotic platforms.

Purpose of the Study:

  • To evaluate the learning curve of an expert surgeon in robotic colorectal procedures.
  • To define performance phases and assess the impact on surgical outcomes.

Main Methods:

  • Retrospective review of 111 robotic colorectal procedures using a prospective database.
  • Cumulative Summation (CUSUM) technique applied to console times to construct the learning curve.
  • Analysis of postoperative outcomes (length of stay, complications, readmissions) and statistical evaluation (Chi-square, ANOVA).

Main Results:

  • The learning curve revealed three distinct performance phases: learning (13 cases), competence (70 cases), and mastery (28 cases).
  • Significant decreases observed in mean surgeon console time (p=0.00017) and median length of stay (p=0.016) over the study period.
  • No significant differences in patient demographics or procedure types across the performance phases; trends towards reduced operative time and complications noted.

Conclusions:

  • Robotic colorectal surgery learning curves typically comprise three phases, supporting the study's findings.
  • This research aids in developing a reliable learning curve for colorectal surgeons transitioning to robotic surgery.
  • The established learning curve can guide structured training and credentialing processes for new robotic surgeons.