Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Sep;25(9):1863-1877.
doi: 10.1111/codi.16695. Epub 2023 Jul 31.

Learning curve for robotic-assisted total mesorectal excision: a multicentre, prospective study

J Arquillière  1 , A Dubois  2 , E Rullier  3 , P Rouanet  4 , Q Denost  5 , B Celerier  3 , D Pezet  2 , G Passot  1   6 , A Aboukassem  2 , P E Colombo  4 , A Mourregot  4 , S Carrere  4 , D Vaudoyer  1   6 , S Gourgou  7 , L Gauthier  7 , E Cotte  1   6
Affiliations
Multicenter Study

Learning curve for robotic-assisted total mesorectal excision: a multicentre, prospective study

J Arquillière et al. Colorectal Dis. 2023 Sep.

Abstract

Aim: Robotic-assisted surgery (RAS) is becoming increasingly important in colorectal surgery. Recognition of the short, safe learning curve (LC) could potentially improve implementation. We evaluated the extent and safety of the LC in robotic resection for rectal cancer.

Method: Consecutive rectal cancer resections (January 2018 to February 2021) were prospectively included from three French centres, involving nine surgeons. LC analyses only included surgeons who had performed more than 25 robotic rectal cancer surgeries. The primary endpoint was operating time LC and the secondary endpoint conversion rate LC. Interphase comparisons included demographic and intraoperative data, operating time, conversion rate, pathological specimen features and postoperative morbidity.

Results: In 174 patients (69% men; mean age 62.6 years) the mean operating time was 334.5 ± 92.1 min. Operative procedures included low anterior resection (n = 143) and intersphincteric resection (n = 31). For operating time, there were two or three (centre-dependent) LC phases. After 12-21 cases (learning phase), there was a significant decrease in total operating time (all centres) and an increase in the number of harvested lymph nodes (two centres). For conversion rate, there were two or four LC phases. After 9-14 cases (learning phase), the conversion rate decreased significantly in two centres; in one centre, there was a nonsignificant decrease despite the treatment of significantly more obese patients and patients with previous abdominal surgery. There were no significant differences in interphase comparisons.

Conclusion: The LC for RAS in rectal cancer was achieved after 12-21 cases for the operating time and 9-14 cases for the conversion rate. RAS for rectal cancer was safe during this time, with no interphase differences in postoperative complications and circumferential resection margin.

Keywords: colorectal surgery; learning curve; rectal cancer; robotic surgery.

PubMed Disclaimer

References

REFERENCES

    1. Weber PA, Merola S, Wasielewski A, Ballantyne GH. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45(12):1689-1694.
    1. Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20(10):1521-1525.
    1. Jiménez Rodríguez RM, Díaz Pavón JM, La Portilla de Juan F, Prendes Sillero E, Hisnard Cadet Dussort JM, Padillo J. Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection. Cirugia Espanola. 2011;89(7):432-8.
    1. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011;54(2):151-156.
    1. Hellan M, Anderson C, Ellenhorn JDI, Paz B, Pigazzi A. Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol. 2007;14(11):3168-3173.

Publication types

LinkOut - more resources