The Learning Curve of Robotic-Assisted Low Rectal Resection of a Novice Rectal Surgeon

AbstractAs with most new surgical technologies, there is an associated learning curve with robotic-assisted total knee arthroplasty (TKA) before surgeons can expect ease of use to be similar to that of manual cases. Therefore, the purpose of this study was to (1) assess robotic-assisted versus manual operative times of two joint reconstructive surgeons separately as well as (2) find an overall learning curve. A total of 240 robotic-assisted TKAs performed by two board-certified surgeons were analyzed. The cases were sequentially grouped into 20 cases and a learning curve was created based on mean operative times. For each surgeon, mean operative times for their first 20 and last 20 robotic-assisted cases were compared with 20 randomly selected manual cases performed by that surgeon as controls prior to the initiation of the robotic-assisted cases. Each of the surgeons first 20 robotic assisted, last 20 robotic assisted, and 20 controls were then combined to create 3 cohorts of 40 cases for analysis. Surgeon 1: First and last robotic cohort operative times were 81 and 70 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 81 versus 68 minutes (p < 0.05). Mean operative times for the last 20 robotic-assisted cases and manual cases were 70 versus 68 minutes (p > 0.05). Surgeon 2: First and last robotic cohort operative times were 117 and 98 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 117 versus 95 (p < 0.05). Mean operative times for the last 20 robotic-cohort cases and manual cases were 98 versus 95 (p > 0.05). A similar trend occurred when the times of two surgeons were combined. The data from this study effectively create a learning curve for the use of robotic-assisted TKA. As both surgeons completed their total cases numbers within similar time frames, these data imply that within a few months, a board-certified orthopaedic joint arthroplasty surgeon should be able to adequately perform robotic TKA without adding any operative times.

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Coloanal J-Pouch Reconstruction Following Low Rectal Resection

Recent Results in Cancer Research - Rectal Cancer ◽

10.1007/978-3-642-71967-7_8 ◽

1998 ◽

pp. 87-94 ◽

Cited By ~ 3

Author(s):

K.-H. Fuchs ◽

M. Sailer ◽

M. Kraemer ◽

A. Thiede

Keyword(s):

Rectal Resection ◽

J Pouch ◽

Pouch Reconstruction ◽

Low Rectal Resection

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Laparoscopic versus Robotic-assisted Rectal Surgery: A Comparison of Postoperative Outcomes

The American Surgeon ◽

10.1177/000313481408001032 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1059-1063

Author(s):

Monica T. Young ◽

Gopal Menon ◽

Timothy F. Feldmann ◽

Steven Mills ◽

Joseph Carmichael ◽

...

Keyword(s):

Rectal Resection ◽

Rectal Surgery ◽

Laparoscopic Group ◽

Postoperative Outcomes ◽

American Society ◽

Laparoscopic Assisted ◽

Low Rectal Resection ◽

Robotic Rectal Resection ◽

American Society Of Anesthesiologists ◽

Invasive Techniques

Rectal surgery continues to be an area of advancement for minimally invasive techniques. However, there is controversy regarding whether a robotic approach imparts any advantages over established laparoscopic procedures. The aim of this study was to analyze and compare outcomes of laparoscopic and robotic rectal resection operations. A single-institution retrospective review was performed identifying 83 consecutive patients undergoing low rectal resection requiring proximal diversion between 2009 and 2013. The cohort was comprised of 38 laparoscopic and 45 robotic cases. Data were analyzed for postoperative outcomes as well as 30-day morbidity and mortality. Male gender frequency, body mass index, and American Society of Anesthesiologists class were higher in the robotic group (71%, 28.6 kg/m2, and 2.6, respectively) compared with the laparoscopic group (42%, 23.7 kg/m2, and 2.2, respectively; P < 0.01). Length of stay was significantly longer for patients undergoing laparoscopic (7.5 days) compared with robotic procedures (5.7 days, P < 0.01). This difference was even greater when comparing patients who underwent a hybrid laparoscopic-assisted open total mesorectal excision (TME) with robotic TME (8.2 vs 5.7 days, respectively, P < 0.01). Conversion rate was 7.9 per cent for the laparoscopic group and zero per cent for the robotic ( P = 0.09). There were no mortalities in either group. A pure laparoscopic or robotic rectal surgery may be associated with a shorter hospital stay compared with a laparoscopic-assisted approach.

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Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience

Canadian Urological Association Journal ◽

10.5489/cuaj.1707 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 92 ◽

Cited By ~ 9

Author(s):

Louis-Olivier Gagnon ◽

Larry Goldenberg ◽

Kenny Lynch ◽

Antonio Hurtado ◽

Martin Gleave

Keyword(s):

Urinary Incontinence ◽

Length Of Stay ◽

Learning Curve ◽

Tertiary Care ◽

Surgical Margin ◽

Hospital Length Of Stay ◽

Positive Surgical Margin ◽

Robotic Assisted ◽

Post Surgery ◽

The Impact

Introduction: We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital.Methods: We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases.Results: The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes.Conclusion: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

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Transition from laparoscopic to robotic rectal resection: outcomes and learning curve of the initial 100 cases

Surgical Endoscopy ◽

10.1007/s00464-020-07731-0 ◽

2020 ◽

Cited By ~ 1

Author(s):

Pim B. Olthof ◽

Louis J. X. Giesen ◽

Teddy S. Vijfvinkel ◽

Daphne Roos ◽

Jan Willem T. Dekker

Keyword(s):

Learning Curve ◽

Rectal Resection ◽

Robotic Rectal Resection

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