Robot-Assisted Cystectomy: Getting Started: Prior Experience, Learning Curve, and Initial Patient Selection

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P < 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

Download Full-text

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.1.1 ◽

2018 ◽

Vol 90 (1) ◽

pp. 1 ◽

Cited By ~ 6

Author(s):

Riccardo Schiavina ◽

Marco Borghesi ◽

Hussam Dababneh ◽

Martina Sofia Rossi ◽

Cristian Vincenzo Pultrone ◽

...

Keyword(s):

Learning Curve ◽

Functional Outcomes ◽

Statistical Significance ◽

Urinary Continence ◽

Operating Table ◽

Open Approach ◽

Robot Assisted ◽

Modular Training ◽

Continence Rate ◽

The Impact

Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.

Download Full-text

28 Learning curve of robot-assisted radical cystectomy with extracorporal urinary diversion

European Urology Supplements ◽

10.1016/s1569-9056(11)61356-0 ◽

2011 ◽

Vol 10 (8) ◽

pp. 541

Author(s):

B. Kassabov ◽

A. Alexandrov ◽

P.M. Lund ◽

Chr. Baermann ◽

J. Popp ◽

...

Keyword(s):

Learning Curve ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Robot Assisted

Download Full-text

Learning Curve for Robot-Assisted Minimally Invasive Thoracoscopic Esophagectomy: Results From 312 Cases

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2018.01.038 ◽

2018 ◽

Vol 106 (1) ◽

pp. 264-271 ◽

Cited By ~ 35

Author(s):

Pieter C. van der Sluis ◽

Jelle P. Ruurda ◽

Sylvia van der Horst ◽

Lucas Goense ◽

Richard van Hillegersberg

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Thoracoscopic Esophagectomy ◽

Robot Assisted

Download Full-text

Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.4.399 ◽

2021 ◽

Vol 93 (4) ◽

pp. 399-403

Author(s):

Hakan Anıl ◽

Kaan Karamık ◽

Ali Yıldız ◽

Murat Savaş

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Surgical Margin ◽

Nerve Sparing ◽

Robot Assisted ◽

Continence Status ◽

Oncological Results ◽

Group 2 ◽

Group 1

Objective: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. Materials and methods: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Results: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Conclusions: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

Download Full-text