Comparative Analysis of Learning Curves in Robotic Versus Laparoscopic Cholecystectomy: A Systematic Review

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Medical Education & Training

Background:

• Robotic surgery offers advantages over conventional laparoscopic surgery (CLS).
• The learning curve for robotic cholecystectomy has not been directly compared to CLC.
• Understanding learning curves is crucial for adopting new surgical techniques.

Purpose of the Study:

• To systematically review and compare the number of cases required to achieve the learning curve for multiport robotic cholecystectomy (MRC), single-site robotic cholecystectomy (SSRC), and conventional laparoscopic cholecystectomy (CLC).
• To assess the heterogeneity and quality of existing studies on robotic surgery learning curves.

Main Methods:

• Systematic review conducted at Barts Cancer Institute.
• Searched Cochrane, PubMed, and Embase databases on March 15, 2024.
• Seventeen studies were included; learning curves were reported in 14. Data collection and verification involved multiple reviewers and Excel.

Main Results:

• Learning curve cases: MRC (16-134), SSRC (10-102), CLC (7-200).
• Operating time improvements were inconsistently measured across 10 studies.
• Significant heterogeneity among studies and small, potentially biased surgeon sample sizes were noted.

Conclusions:

• The learning curves for robotic and conventional laparoscopic cholecystectomy show considerable variation.
• High heterogeneity and methodological limitations in current studies hinder definitive comparisons.
• Higher-quality research is needed to establish conclusive benefits of robotic surgery learning curves for MRC and SSRC.