Analysis and development of the learning curve in robotic colorectal surgery at a specialized center

Robotic colorectal surgery has emerged as an alternative to laparoscopy, offering technical advantages particularly in complex procedures such as rectal surgery. However, its adoption is influenced by the learning curve, which remains incompletely characterized according to tumor location. Cumulative sum (CUSUM) analysis provides an objective method to assess surgical learning curves. A retrospective analysis of 60 consecutive patients undergoing robotic colorectal surgery was performed. The learning curve was evaluated using CUSUM analysis of total operative time. Patients were stratified according to tumor location into right colon (n = 23), sigmoid colon (n = 16), and rectum (n = 21). Perioperative outcomes, including operative time, console time, and postoperative complications, were compared among groups. Non-parametric tests and proportion analyses were used, with statistical significance set at p < 0.05. Operative time was significantly longer in rectal surgery compared to right colon and sigmoid procedures (median: 205.0 vs 145.0 vs 175.0 min; p = 0.000306). Similarly, console time was higher in the rectal group (180.0 vs 127.5 vs 154.0 min; p = 0.000215). No significant differences were observed in postoperative complication rates among groups (p = 0.191). CUSUM analysis identified inflection points at case 6 for right colon, case 5 for sigmoid colon, and case 8 for rectal surgery, indicating a more prolonged learning curve for rectal procedures. The learning curve in robotic colorectal surgery depends on tumor location. Right colectomies show a faster acquisition of technical skills, whereas rectal surgery requires a greater number of cases to achieve stabilization of operative performance. Likewise, procedural safety is maintained during the learning phase, reaching a stable point on the curve after approximately 20 cases, in agreement with the global literature.