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The multiphasic learning curve for robot-assisted rectal surgery

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Abstract

Background

Robotic rectal surgery is gaining in popularity. We aimed to define the learning curve of an experienced laparoscopic colorectal surgeon in performing robot-assisted rectal surgery. We hypothesized that there are multiple phases in this learning process.

Methods

We performed a retrospective analysis. Consecutive patients who underwent robot-assisted rectal surgery between July 2007 and August 2011 were identified. Operating times were analyzed using the CUSUM (cumulative sum) technique. CUSUMs were model fitted as a fourth-order polynomial. χ2, Fisher’s exact, two independent samples t test, one-way ANOVA, Kruskal–Wallis, and Mann–Whitney tests were used. A p value of <0.05 was considered statistically significant.

Results

We identified 197 patients. The median (range) total operative, robot, console, and docking times (min) were 265 (145–515), 140 (59–367), 135 (50–360), and 5 (3–40), respectively. CUSUM analysis of docking time showed a learning curve of 35 cases. CUSUM analysis of total operative, robot, and console times demonstrated three phases. The first phase (35 patients) represented the initial learning curve. The second phase (93 patients) involved more challenging cases with increased operative time. The third phase (69 patients) represented the concluding phase in the learning curve. There was increased complexity of cases in the latter two phases. Of phase 1 patients, 45.7 % had tumors ≤7 cm from the anal verge compared to 64.2 % in phases 2 and 3 (p = 0.042). Of phase 1 patients, 2.9 % had neoadjuvant chemoradiotherapy compared to 32.7 % of patients in phases 2 and 3 (p < 0.001). Splenic flexure was mobilized in 8.6 % of phase 1 patients compared to 56.8 % of patients in phases 2 and 3 (p < 0.001). Median blood loss was <50 ml in all three phases. The patients in phases 2 and 3 had a longer hospital stay compared to those in phase 1 (9 vs. 8 days, p = 0.002). There were no conversions.

Conclusion

At least three phases in the learning curve for robot-assisted rectal surgery are defined in our study.

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Disclosures

Kevin Kaity Sng, Masayasu Hara, Jae-Won Shin, Byung-Eun Yoo, Kyung-Sook Yang, and Seon-Hahn Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Sungbook-gu, Seoul, 136-705, Republic of Korea

    Kevin Kaity Sng, Masayasu Hara, Jae-Won Shin, Byung-Eun Yoo & Seon-Hahn Kim

  2. Colorectal Service, Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore

    Kevin Kaity Sng

  3. Department of Gastroenterological Surgery, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Masayasu Hara

  4. Department of Biostatistics, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Sungbook-gu, Seoul, 136-705, Republic of Korea

    Kyung-Sook Yang

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  1. Kevin Kaity Sng
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Correspondence to Seon-Hahn Kim.

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Sng, K.K., Hara, M., Shin, JW. et al. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27, 3297–3307 (2013). https://doi.org/10.1007/s00464-013-2909-4

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  • DOI: https://doi.org/10.1007/s00464-013-2909-4

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