Learning curve for robotic-assisted total mesorectal excision: a multicentre, prospective study.

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Robotics in Medicine

Background:

• Robotic-assisted surgery (RAS) is increasingly adopted in colorectal procedures.
• Understanding the learning curve (LC) is crucial for efficient RAS implementation.
• This study focuses on the LC for robotic rectal cancer resections.

Purpose of the Study:

• To evaluate the extent and safety of the learning curve (LC) in robotic rectal cancer surgery.
• To identify the number of cases required to achieve proficiency in operating time and conversion rates.
• To assess the safety of RAS during the LC phase.

Main Methods:

• Prospective inclusion of consecutive rectal cancer resections from three centers (Jan 2018-Feb 2021).
• Analysis included surgeons with >25 robotic rectal cancer surgeries.
• Primary endpoint: operating time LC; Secondary endpoint: conversion rate LC. Interphase comparisons included operative and postoperative data.

Main Results:

• The learning curve for operating time was achieved after 12-21 cases, showing significant decreases in operative time and increased lymph node harvest.
• The learning curve for conversion rate was achieved after 9-14 cases, with significant decreases in two centers.
• No significant differences in postoperative morbidity or margin status were observed between learning phases.

Conclusions:

• The learning curve for robotic-assisted surgery in rectal cancer is relatively short, with proficiency in operating time reached by 12-21 cases and conversion rates by 9-14 cases.
• Robotic-assisted surgery for rectal cancer is safe during the learning curve period.
• These findings support the efficient implementation of RAS for rectal cancer treatment.