Safety of Proctored Learning Curve in Upper Gastrointestinal Robotic Surgery

Area of Science:

• Minimally invasive surgery
• Surgical oncology
• Robotic surgery

Background:

• Implementing robotic upper gastrointestinal surgery requires a structured learning process.
• This study details the initial experience and outcomes of adopting this technique in Argentina.
• The Upper GI International Robotic Association (UGIRA) training pathway was utilized.

Purpose of the Study:

• To report the initial experience, outcomes, and learning curve of robotic upper gastrointestinal surgery in Argentina.
• To evaluate the feasibility and safety of the UGIRA training pathway with telementoring.
• To assess the learning curve plateau for operative time and lymph node yield.

Main Methods:

• Prospective data collection of patients undergoing robotic upper gastrointestinal surgery (Da Vinci Xi®).
• Proctored by an experienced international team via on-site or remote telementoring.
• Cumulative Sum (CUSUM) analysis used to determine learning curve plateau for operative time and lymph node yield.

Main Results:

• 66 procedures performed: 26 esophagectomies (RAMIE), 8 gastrectomies, 32 benign procedures.
• No major complications, conversions, or mortality in the benign group.
• In RAMIE cohort: 34.6% major complications, 15.4% anastomotic leak, 3.8% mortality, 96.2% R0 resection. Operative time plateau at case 7, lymph node yield trough at case 18.

Conclusions:

• Robotic upper gastrointestinal surgery implementation in Argentina appears feasible and safe.
• Acceptable short-term perioperative and oncologic outcomes were observed.
• The UGIRA pathway, enhanced by telementoring, supports successful adoption of this surgical technique.