Learning Curve and Safety Analysis After 170 Robot-Assisted Cases in Thoracic Surgery

Robot-assisted thoracic surgery (RATS) is becoming increasingly popular due to technological advancements that enhance surgical outcomes. RATS was introduced at The Ottawa Hospital in 2022. This study aims to assess surgeon performance over time by analyzing learning curves for surgical efficiency and evaluating safety.

Ethics approval was obtained for a prospective registry of all robotic cases. We analyzed 170 consecutive RATS procedures (April 2022 to November 2024) and 340 time-matched video-assisted thoracoscopic surgery (VATS) procedures. Descriptive statistics were calculated in Excel. Learning curves and operative times for lobectomies and anterior mediastinal resections were assessed using CUSUM analysis in R, with console time as a surrogate. Safety was evaluated using the Ottawa Thoracic Morbidity and Mortality schema for adverse events.

The mean console time for all cases (N = 144) was 126 min, with a mean docking time of 24 min. For both lobectomies and anterior mediastinal resections, the acquisition of procedural efficiency was achieved after 20 cases and 7 cases, respectively. Safety outcomes were comparable to VATS, with most (n = 43, 73%) being grade II prolonged air leak (n = 19, 32%). Conversions to VATS occurred in 14 cases (8%), primarily due to complex anatomy, with only 3 cases (2%) converted to open. No conversions were done urgently.

The introduction of RATS is safe, with procedure efficiency being achieved within a reasonable number of cases.