Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Hernia Repair Outcomes

Background:

• Robotic abdominal wall reconstruction (rAWR) is increasingly used for complex hernia repairs.
• The learning curve for rAWR is not well-defined, impacting proficiency assessment.
• Understanding optimal case volume is crucial for surgeon training and patient safety.

Purpose of the Study:

• To analyze skill acquisition in robotic abdominal wall reconstruction (rAWR).
• To describe the learning curve and identify optimal case volume for rAWR proficiency.
• To evaluate operative time trends during the learning process.

Main Methods:

• Retrospective analysis of 185 consecutive robotic abdominal wall reconstruction (rAWR) cases (2018-2022).
• Operative time (console time) was the primary outcome measure.
• Cumulative sum (CUSUM) analysis was used to define skill acquisition phases.

Main Results:

• Average operative time decreased over the study period.
• CUSUM analysis revealed four distinct skill acquisition phases: Initial Learning Curve (0-20 cases), Stabilization (21-55), Second Learning Curve (56-70), and Skill Proficiency (>70).
• Significant operative time reduction was observed after 70 cases.

Conclusions:

• Robotic abdominal wall reconstruction (rAWR) demonstrates identifiable stages of skill acquisition.
• A minimum of 70 cases appears necessary to reach skill proficiency in rAWR.
• Further research is needed to validate the optimal case volume for rAWR competency.