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Early learning curve changes in objective performance indicators during robotic cholecystectomy.

Derrick Liu1, Mallory Shields2, Catherine Stricklin2

  • 1Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, CT, United States.

Frontiers in Surgery
|October 27, 2025
PubMed
Summary
This summary is machine-generated.

Experienced laparoscopic surgeons can now track their robotic surgery proficiency using objective performance indicators (OPIs). This study identified key metrics and determined proficiency is reached after approximately 22 robotic cholecystectomy operations.

Keywords:
learning curveligation/division of the cystic ductobjective performance indicatorsrobotic cholecystectomytransition from laparoscopic to robotic cholecystectomy

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Robotics
  • Surgical Education

Background:

  • The learning curve for experienced laparoscopic surgeons transitioning to robotic surgery remains undefined.
  • Objective performance indicators (OPIs) offer quantifiable metrics for surgical behavior analysis.
  • Robotic-assisted surgery is increasingly adopted, necessitating efficient training paradigms.

Purpose of the Study:

  • To identify objective performance indicators (OPIs) that define proficiency in robotic cholecystectomy for surgeons transitioning from laparoscopy.
  • To establish the learning curve and determine the number of operations required for proficiency.
  • To provide insights into critical surgical steps during this transition.

Main Methods:

  • Analysis of objective performance indicators (OPIs) during robotic cholecystectomy.
  • Utilized CUSUM (Cumulative Sum) analysis to generate a learning curve for idle time.
  • Tracked metrics such as robotic arm movement, master clutch use, and camera dynamics.

Main Results:

  • Proficiency in reducing idle time was achieved after 22 operations, as indicated by CUSUM analysis.
  • Significant improvements observed in decreased time of robotic arm movement for cystic duct ligation/division (p=0.042).
  • Increased master clutch use for cystic artery ligation/division (p=0.009) and enhanced camera velocity, acceleration, and smoothness were noted.

Conclusions:

  • Objective performance indicators (OPIs) can effectively track the learning curve for robotic cholecystectomy.
  • Cystic duct ligation/division presents a significant learning curve during the transition from laparoscopic to robotic surgery.
  • This study identifies key OPIs crucial for future proficiency assessment in robotic surgical training.