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Impact of proctoring on the learning curve of robotic-assisted low anterior resection: a multicenter retrospective
Keisuke Noda1, Tetsuro Tominaga1, Shintaro Hashimoto1
1Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Background:
Robotic-assisted surgery has become an established technique for rectal cancer, providing enhanced visualization and precision. However, the learning curve for robotic-assisted low anterior resection remains steep due to complex pelvic anatomy and technical challenges. Proctoring-supervised instruction by an experienced surgeon-has been introduced to facilitate early skill acquisition, yet its quantitative impact on robotic-assisted surgery remains unclear.
Methods:
This multicenter retrospective study included 131 patients who underwent robotic-assisted low anterior resection or ultra-low anterior resection for lower rectal cancer between July 2018 and June 2024. Patients were divided into two groups: those who underwent surgery at facilities with and without a certified proctor (Proctor group, n = 58; Non-proctor group, n = 73). Operative outcomes, console time to rectal transection, and learning curves were analyzed using linear regression and cumulative sum analysis.
Results:
The Proctor group demonstrated significantly shorter operative and console times compared to the Non-proctor group (257 vs. 323 min, p < 0.001; 154 vs. 184 min, p < 0.001). In the first 10 cases, console times were markedly shorter in the Proctor group, indicating greater operative efficiency in the early phase. Cumulative sum analysis showed that the curve reached its peak at 13 cases in the Proctor group and 16 cases in the Non-proctor group, indicating earlier stabilization of console time in the Proctor group. No significant differences were observed in complication rates or oncologic parameters between the groups.
Conclusions:
Structured proctoring was associated with shorter console times and earlier stabilization of console time during the initial phase of robotic-assisted low anterior resection. Although the overall rate of improvement and long-term outcomes were comparable between groups, structured proctoring may help improve operative efficiency during the early stages of program implementation.
