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A systematic review of the learning curve in robotic surgery: range and heterogeneity

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Abstract

Background

With the rapid adoption of the robotic surgery, more and more learning curve (LC) papers are being published but there is no set definition of what should constitute a rigorous analysis and represent a true LC. A systematic review of the robotic surgical literature was undertaken to determine the range and heterogeneity of parameters reported in studies assessing the LC in robotic surgery.

Methods

The search was conducted in July 2017 in PubMed. All studies reporting a LC in robotic surgery were included. 268 (25%) of the identified studies met the inclusion criteria.

Results

102 (38%) studies did not define nor explicitly state the LC with appropriate evidence; 166 studies were considered for quantitative analysis. 46 different parameters of 6 different outcome domains were reported with a median of two parameters (1–8) and 1 domain (1–5) per study. Overall, three domains were only technical and three domains were both technical and clinical/patient-centered outcomes. The two most commonly reported domains were operative time [146 studies (88%)] and intraoperative outcomes [31 studies (19%)]. Postoperative outcomes [16 studies (9%)] and surgical success [11 studies (7%)] were reported infrequently. Purely technical outcomes were the most frequently used to assess LC [131 studies (79%)].

Conclusions

The outcomes reported in studies assessing LC in robotic surgery are extremely heterogeneous and are most often technical indicators of surgical performance rather than clinical and patient-centered outcomes. There is no single outcome that best represents the surgical success. A standardized multi-outcome approach to assessing LC is recommended.

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References

  1. Catchpole K, Perkins C, Bresee C, Solnik MJ, Sherman B, Fritch J et al (2016) Safety, efficiency and learning curves in robotic surgery: a human factors analysis. Surg Endosc 30(9):3749–3761

    Article  PubMed  Google Scholar 

  2. de la Fuente SG, Weber J, Hoffe SE, Shridhar R, Karl R, Meredith KL (2013) Initial experience from a large referral center with robotic-assisted Ivor Lewis esophagogastrectomy for oncologic purposes. Surg Endosc 27(9):3339–3347

    Article  PubMed  Google Scholar 

  3. Kaul S, Shah NL, Menon M (2006) Learning curve using robotic surgery. Curr Urol Rep 7(2):125–129

    Article  PubMed  Google Scholar 

  4. Alemozaffar M, Duclos A, Hevelone ND, Lipsitz SR, Borza T, Yu H-Y et al (2012) Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function. Eur Urol 61(6):1222–1228

    Article  PubMed  Google Scholar 

  5. Sharma NL, Papadopoulos A, Lee D, McLoughlin J, Vowler SL, Baumert H et al (2011) First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int 108(5):739–747

    PubMed  Google Scholar 

  6. Dal Moro F, Secco S, Valotto C, Artibani W, Zattoni F (2012) Specific learning curve for port placement and docking of da Vinci(®) Surgical System: one surgeon’s experience in robotic-assisted radical prostatectomy. J Robot Surg 6(4):323–327

    Article  CAS  PubMed  Google Scholar 

  7. Gumus E, Boylu U, Turan T, Onol FF (2011) The learning curve of robot-assisted radical prostatectomy. J Endourol 25(10):1633–1637

    Article  PubMed  Google Scholar 

  8. Hashimoto T, Yoshioka K, Gondo T, Kamoda N, Satake N, Ozu C et al (2013) Learning curve and perioperative outcomes of robot-assisted radical prostatectomy in 200 initial Japanese cases by a single surgeon. J Endourol 27(10):1218–1223

    Article  PubMed  Google Scholar 

  9. Lebeau T, Rouprêt M, Ferhi K, Chartier-Kastler E, Bitker M-O, Richard F et al (2012) The role of a well-trained team on the early learning curve of robot-assisted laparoscopic procedures: the example of radical prostatectomy. Int J Med Robot Comput Assist Surg MRCAS 8(1):67–72

    Article  Google Scholar 

  10. Ou Y-C, Yang C-R, Wang J, Yang C-K, Cheng C-L, Patel VR et al (2011) The learning curve for reducing complications of robotic-assisted laparoscopic radical prostatectomy by a single surgeon. BJU Int 108(3):420–425

    Article  PubMed  Google Scholar 

  11. Sammon J, Perry A, Beaule L, Kinkead T, Clark D, Hansen M (2010) Robot-assisted radical prostatectomy: learning rate analysis as an objective measure of the acquisition of surgical skill. BJU Int 106(6):855–860

    Article  PubMed  Google Scholar 

  12. Hong YM, Sutherland DE, Linder B, Engel JD (2010) “Learning curve” may not be enough: assessing the oncological experience curve for robotic radical prostatectomy. J Endourol 24(3):473–477

    Article  PubMed  Google Scholar 

  13. Doumerc N, Yuen C, Savdie R, Rahman MB, Pe Benito R, Stricker P (2010) Robot-assisted laparoscopic prostatectomy: analysis of an experienced open surgeon’s learning curve after 300 procedures. J Robot Surg 3(4):229–234

    Article  PubMed  Google Scholar 

  14. Doumerc N, Yuen C, Savdie R, Rahman MB, Rasiah KK, Pe Benito R et al (2010) Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 106(3):378–384

    Article  PubMed  Google Scholar 

  15. Jaffe J, Castellucci S, Cathelineau X, Harmon J, Rozet F, Barret E et al (2009) Robot-assisted laparoscopic prostatectomy: a single-institutions learning curve. Urology 73(1):127–133

    Article  PubMed  Google Scholar 

  16. Mayer EK, Winkler MH, Aggarwal R, Karim O, Ogden C, Hrouda D et al (2006) Robotic prostatectomy: the first UK experience. Int J Med Robot Comput Assist Surg MRCAS 2(4):321–328

    Article  CAS  Google Scholar 

  17. Samadi D, Levinson A, Hakimi A, Shabsigh R, Benson MC (2007) From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol 25(1):105–110

    Article  PubMed  Google Scholar 

  18. Good DW, Stewart GD, Laird A, Stolzenburg J-U, Cahill D, McNeill SA (2015) A critical analysis of the learning curve and postlearning curve outcomes of two experience- and volume-matched surgeons for laparoscopic and robot-assisted radical prostatectomy. J Endourol 29(8):939–947

    Article  PubMed  Google Scholar 

  19. Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP et al (2017) Learning curve of minimally invasive radical prostatectomy: comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 35(4):149.e1-149.e6

    Article  PubMed  Google Scholar 

  20. Thompson JE, Egger S, Böhm M, Haynes A-M, Matthews J, Rasiah K et al (2014) Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. Eur Urol 65(3):521–531

    Article  PubMed  Google Scholar 

  21. Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME (2011) Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology 78(4):813–819

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lavery HJ, Small AC, Samadi DB, Palese MA (2011) Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS 15(3):291–297

    Article  PubMed  PubMed Central  Google Scholar 

  23. Haseebuddin M, Benway BM, Cabello JM, Bhayani SB (2010) Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol 24(1):57–61

    Article  PubMed  Google Scholar 

  24. Xie Y, Ma X, Gu L, Li H, Lv X, Gao Y et al (2016) Associating the learning curve and tumor anatomical complexity with the margins, ischemia, and complications rate after robot-assisted partial nephrectomy. Int J Surg Lond Engl 36(Pt A):219–224

    Article  Google Scholar 

  25. Dube H, Bahler CD, Sundaram CP (2015) The learning curve and factors affecting warm ischemia time during robot-assisted partial nephrectomy. Indian J Urol 31(3):223–228

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hanzly M, Frederick A, Creighton T, Atwood K, Mehedint D, Kauffman EC et al (2015) Learning curves for robot-assisted and laparoscopic partial nephrectomy. J Endourol 29(3):297–303

    Article  PubMed  Google Scholar 

  27. Sorensen MD, Delostrinos C, Johnson MH, Grady RW, Lendvay TS (2011) Comparison of the learning curve and outcomes of robotic assisted pediatric pyeloplasty. J Urol 185(6 Suppl):2517–2522

    Article  PubMed  Google Scholar 

  28. Tasian GE, Wiebe DJ, Casale P (2013) Learning curve of robotic assisted pyeloplasty for pediatric urology fellows. J Urol 190(4 Suppl):1622–1626

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cundy TP, Gattas NE, White AD, Najmaldin AS (2015) Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty. J Pediatr Surg 50(8):1368–1373

    Article  PubMed  Google Scholar 

  30. Kuo L-J, Lin Y-K, Chang C-C, Tai C-J, Chiou J-F, Chang Y-J (2014) Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis 29(5):555–562

    Article  PubMed  Google Scholar 

  31. Jiménez-Rodríguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28(6):815–821

    Article  PubMed  Google Scholar 

  32. Sng KK, Hara M, Shin J-W, Yoo B-E, Yang K-S, Kim S-H (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27(9):3297–3307

    Article  PubMed  Google Scholar 

  33. Raimondi P, Marchegiani F, Cieri M, Cichella A, Cotellese R, Innocenti P (2018) Is right colectomy a complete learning procedure for a robotic surgical program? J Robot Surg 12(1):147–155

    Article  PubMed  Google Scholar 

  34. Parisi A, Scrucca L, Desiderio J, Gemini A, Guarino S, Ricci F et al (2017) Robotic right hemicolectomy: analysis of 108 consecutive procedures and multidimensional assessment of the learning curve. Surg Oncol 26(1):28–36

    Article  PubMed  Google Scholar 

  35. Odermatt M, Ahmed J, Panteleimonitis S, Khan J, Parvaiz A (2017) Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 31(10):4067–4076

    Article  PubMed  Google Scholar 

  36. Guend H, Widmar M, Patel S, Nash GM, Paty PB, Guillem JG et al (2017) Developing a robotic colorectal cancer surgery program: understanding institutional and individual learning curves. Surg Endosc 31(7):2820–2828

    Article  PubMed  Google Scholar 

  37. Morelli L, Guadagni S, Lorenzoni V, Di Franco G, Cobuccio L, Palmeri M et al (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Colorectal Dis 31(9):1639–1648

    Article  PubMed  Google Scholar 

  38. Foo CC, Law WL (2016) The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg 40(2):456–462

    Article  PubMed  Google Scholar 

  39. Park EJ, Kim CW, Cho MS, Kim DW, Min BS, Baik SH et al (2014) Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer?: a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Medicine (Baltimore) 93(25):e109

    Article  Google Scholar 

  40. Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK et al (2015) Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc 29(3):558–568

    Article  PubMed  Google Scholar 

  41. Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS et al (2014) Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28(10):2821–2831

    Article  PubMed  Google Scholar 

  42. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25(3):855–860

    Article  PubMed  Google Scholar 

  43. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2016) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today 46(8):957–962

    Article  PubMed  Google Scholar 

  44. D’Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G et al (2011) Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res 166(2):e113–e120

    Article  PubMed  Google Scholar 

  45. Ayloo S, Fernandes E, Choudhury N (2014) Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-Y gastric bypass. Surg Endosc 28(5):1629–1633

    Article  PubMed  Google Scholar 

  46. Buchs NC, Pugin F, Bucher P, Hagen ME, Chassot G, Koutny-Fong P et al (2012) Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc 26(4):1116–1121

    Article  PubMed  Google Scholar 

  47. Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY et al (2012) Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol 38(1):57–63

    Article  CAS  PubMed  Google Scholar 

  48. Hernandez JM, Dimou F, Weber J, Almhanna K, Hoffe S, Shridhar R et al (2013) Defining the learning curve for robotic-assisted esophagogastrectomy. J Gastrointest Surg 17(8):1346–1351

    Article  PubMed  Google Scholar 

  49. Kim H-I, Park MS, Song KJ, Woo Y, Hyung WJ (2014) Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol 40(10):1346–1354

    Article  PubMed  Google Scholar 

  50. Renaud M, Reibel N, Zarnegar R, Germain A, Quilliot D, Ayav A et al (2013) Multifactorial analysis of the learning curve for totally robotic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 23(11):1753–1760

    Article  PubMed  Google Scholar 

  51. Vilallonga R, Fort JM, Gonzalez O, Caubet E, Boleko A, Neff KJ et al (2012) The initial learning curve for robot-assisted sleeve gastrectomy: a surgeon’s experience while introducing the robotic technology in a Bariatric Surgery Department. Minim Invasive Surg 2012:347131

    PubMed  PubMed Central  Google Scholar 

  52. Yang SY, Roh KH, Kim Y-N, Cho M, Lim SH, Son T et al (2017) Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol 24(7):1770–1777

    Article  PubMed  Google Scholar 

  53. Shibasaki S, Suda K, Nakauchi M, Kikuchi K, Kadoya S, Ishida Y et al (2017) Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc 31(10):4283–4297

    Article  PubMed  Google Scholar 

  54. Zhou J, Shi Y, Qian F, Tang B, Hao Y, Zhao Y et al (2015) Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol 111(6):760–767

    Article  PubMed  Google Scholar 

  55. Galvani CA, Loebl H, Osuchukwu O, Samamé J, Apel ME, Ghaderi I (2016) Robotic-assisted paraesophageal hernia repair: initial experience at a single institution. J Laparoendosc Adv Surg Tech A 26(4):290–295

    Article  PubMed  Google Scholar 

  56. Sarkaria IS, Latif MJ, Bianco VJ, Bains MS, Rusch VW, Jones DR et al (2017) Early operative outcomes and learning curve of robotic assisted giant paraesophageal hernia repair. Int J Med Robot Comput Assist Surg MRCAS 13(1):e1730

    Article  Google Scholar 

  57. Cundy TP, Rowland SP, Gattas NE, White AD, Najmaldin AS (2015) The learning curve of robot-assisted laparoscopic fundoplication in children: a prospective evaluation and CUSUM analysis. Int J Med Robot Comput Assist Surg MRCAS 11(2):141–149

    Article  Google Scholar 

  58. Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP et al (2012) Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26(6):1648–1655

    Article  PubMed  Google Scholar 

  59. D’Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G et al (2012) Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot Comput Assist Surg MRCAS 8(4):483–490

    Article  Google Scholar 

  60. Brunaud L, Ayav A, Zarnegar R, Rouers A, Klein M, Boissel P et al (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144(6):995–1001 (discussion 1001)

    Article  PubMed  Google Scholar 

  61. Vidovszky TJ, Smith W, Ghosh J, Ali MR (2006) Robotic cholecystectomy: learning curve, advantages, and limitations. J Surg Res 136(2):172–178

    Article  PubMed  Google Scholar 

  62. Efanov M, Alikhanov R, Tsvirkun V, Kazakov I, Melekhina O, Kim P et al (2017) Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB 19(9):818–824

    Article  PubMed  Google Scholar 

  63. Chen P-D, Wu C-Y, Hu R-H, Chen C-N, Yuan R-H, Liang J-T et al (2017) Robotic major hepatectomy: is there a learning curve? Surgery 161(3):642–649

    Article  PubMed  Google Scholar 

  64. Napoli N, Kauffmann EF, Perrone VG, Miccoli M, Brozzetti S, Boggi U (2015) The learning curve in robotic distal pancreatectomy. Updat Surg 67(3):257–264

    Article  Google Scholar 

  65. Kubat E, Hansen N, Nguyen H, Wren SM, Eisenberg D (2016) Urgent and elective robotic single-site cholecystectomy: analysis and learning curve of 150 consecutive cases. J Laparoendosc Adv Surg Tech A 26(3):185–191

    Article  PubMed  Google Scholar 

  66. Lee GS, Arghami A, Dy BM, McKenzie TJ, Thompson GB, Richards ML (2016) Robotic single-site adrenalectomy. Surg Endosc 30(8):3351–3356

    Article  PubMed  Google Scholar 

  67. Bibi S, Rahnemai-Azar AA, Coralic J, Bayoumi M, Khorsand J, Farkas DT et al (2015) Single-site robotic cholecystectomy: the timeline of progress. World J Surg 39(10):2386–2391

    Article  PubMed  Google Scholar 

  68. Benizri EI, Germain A, Ayav A, Bernard J-L, Zarnegar R, Benchimol D et al (2014) Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy. J Robot Surg 8(2):125–132

    Article  PubMed  Google Scholar 

  69. Pietrabissa A, Sbrana F, Morelli L, Badessi F, Pugliese L, Vinci A et al (2012) Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg (Chicago Ill 1960) 147(8):709–714

    Article  Google Scholar 

  70. Lenihan JP, Kovanda C, Seshadri-Kreaden U (2008) What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 15(5):589–594

    Article  PubMed  Google Scholar 

  71. Lopez S, Mulla ZD, Hernandez L, Garza DM, Payne TN, Farnam RW (2016) A comparison of outcomes between robotic-assisted, single-site laparoscopy versus laparoendoscopic single site for benign hysterectomy. J Minim Invasive Gynecol 23(1):84–88

    Article  PubMed  Google Scholar 

  72. El Hachem L, Momeni M, Friedman K, Moshier EL, Chuang LT, Gretz HF (2016) Safety, feasibility and learning curve of robotic single-site surgery in gynecology. Int J Med Robot Comput Assist Surg MRCAS 12(3):509–516

    Article  Google Scholar 

  73. Mäenpää M, Nieminen K, Tomás E, Luukkaala T, Mäenpää JU (2015) Implementing robotic surgery to gynecologic oncology: the first 300 operations performed at a tertiary hospital. Acta Obstet Gynecol Scand 94(5):482–488

    Article  PubMed  Google Scholar 

  74. Cela V, Freschi L, Simi G, Ruggiero M, Tana R, Pluchino N (2013) Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome. Surg Endosc 27(7):2638–2643

    Article  CAS  PubMed  Google Scholar 

  75. Lim PC, Kang E, Park DH (2010) Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer. J Minim Invasive Gynecol 17(6):739–748

    Article  PubMed  Google Scholar 

  76. Lim PC, Kang E, Park DH (2011) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 120(3):413–418

    Article  PubMed  Google Scholar 

  77. Woelk JL, Casiano ER, Weaver AL, Gostout BS, Trabuco EC, Gebhart JB (2013) The learning curve of robotic hysterectomy. Obstet Gynecol 121(1):87–95

    Article  PubMed  Google Scholar 

  78. Yim GW, Kim SW, Nam EJ, Kim S, Kim YT (2013) Learning curve analysis of robot-assisted radical hysterectomy for cervical cancer: initial experience at a single institution. J Gynecol Oncol 24(4):303–312

    Article  PubMed  PubMed Central  Google Scholar 

  79. Lowe MP, Johnson PR, Kamelle SA, Kumar S, Chamberlain DH, Tillmanns TD (2009) A multiinstitutional experience with robotic-assisted hysterectomy with staging for endometrial cancer. Obstet Gynecol 114(2 Pt 1):236–243

    Article  PubMed  Google Scholar 

  80. Seamon LG, Cohn DE, Richardson DL, Valmadre S, Carlson MJ, Phillips GS et al (2008) Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol 112(6):1207–1213

    Article  PubMed  Google Scholar 

  81. Seamon LG, Fowler JM, Richardson DL, Carlson MJ, Valmadre S, Phillips GS et al (2009) A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol 114(2):162–167

    Article  PubMed  Google Scholar 

  82. Favre A, Huberlant S, Carbonnel M, Goetgheluck J, Revaux A, Ayoubi JM (2016) Pedagogic approach in the surgical learning: the first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy. Front Surg 3:58

    Article  PubMed  PubMed Central  Google Scholar 

  83. Yaribakht S, Guillemin F, Harter V, Malartic C, Marchal F (2015) [New approach of learning curve for robotic-assisted gynecologic oncology surgery]. Gynecol Obstet Fertil 43(5):348–355

    Article  CAS  PubMed  Google Scholar 

  84. Akdemir A, Zeybek B, Ozgurel B, Oztekin MK, Sendag F (2015) Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy. J Minim Invasive Gynecol 22(3):384–389

    Article  PubMed  Google Scholar 

  85. Sharma S, Calixte R, Finamore PS (2016) Establishing the learning curve of robotic sacral colpopexy in a start-up robotics program. J Minim Invasive Gynecol 23(1):89–93

    Article  PubMed  Google Scholar 

  86. Linder BJ, Anand M, Weaver AL, Woelk JL, Klingele CJ, Trabuco EC et al (2016) Assessing the learning curve of robotic sacrocolpopexy. Int Urogynecol J 27(2):239–246

    Article  PubMed  Google Scholar 

  87. Geller EJ, Lin F-C, Matthews CA (2013) Analysis of robotic performance times to improve operative efficiency. J Minim Invasive Gynecol 20(1):43–48

    Article  PubMed  Google Scholar 

  88. Ciabatti PG, Burali G, D’Ascanio L (2012) Single-incision robot-assisted transaxillary surgery for early-stage papillary thyroid cancer. Ann Otol Rhinol Laryngol 121(12):811–815

    Article  PubMed  Google Scholar 

  89. Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214(4):558–564 (discussion 564–566)

    Article  PubMed  Google Scholar 

  90. Lee J, Yun JH, Choi UJ, Kang S-W, Jeong JJ, Chung WY (2012) Robotic versus endoscopic thyroidectomy for thyroid cancers: a multi-institutional analysis of early postoperative outcomes and surgical learning curves. J Oncol 2012:734541

    PubMed  PubMed Central  Google Scholar 

  91. Kim WW, Jung JH, Park HY (2015) A single surgeon’s experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach. J Surg Oncol 111(2):135–140

    Article  PubMed  Google Scholar 

  92. Park JH, Lee J, Hakim NA, Kim HY, Kang S-W, Jeong JJ et al (2015) Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery. Head Neck 37(12):1705–1711

    Article  PubMed  Google Scholar 

  93. Albergotti WG, Gooding WE, Kubik MW, Geltzeiler M, Kim S, Duvvuri U et al (2017) Assessment of surgical learning curves in transoral robotic surgery for squamous cell carcinoma of the oropharynx. JAMA Otolaryngol—Head Neck Surg 143(6):542–548

    Article  PubMed  PubMed Central  Google Scholar 

  94. Hu X, Lieberman IH (2014) What is the learning curve for robotic-assisted pedicle screw placement in spine surgery? Clin Orthop 472(6):1839–1844

    Article  PubMed  Google Scholar 

  95. Schatlo B, Martinez R, Alaid A, von Eckardstein K, Akhavan-Sigari R, Hahn A et al (2015) Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir 157(10):1819–1823 (discussion 1823)

    Article  PubMed  Google Scholar 

  96. Novotný T, Dvorák M, Staffa R (2011) The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease. J Vasc Surg 53(2):414–420

    Article  PubMed  Google Scholar 

  97. Hemli JM, Henn LW, Panetta CR, Suh JS, Shukri SR, Jennings JM et al (2013) Defining the learning curve for robotic-assisted endoscopic harvesting of the left internal mammary artery. Innov Phila Pa 8(5):353–358

    Google Scholar 

  98. Sudan R, Bennett KM, Jacobs DO, Sudan DL (2012) Multifactorial analysis of the learning curve for robot-assisted laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg 255(5):940–945

    Article  PubMed  Google Scholar 

  99. Paulucci DJ, Abaza R, Eun DD, Hemal AK, Badani KK (2017) Robot-assisted partial nephrectomy: continued refinement of outcomes beyond the initial learning curve. BJU Int 119(5):748–754

    Article  PubMed  Google Scholar 

  100. Oviedo RJ, Robertson JC, Alrajhi S (2016) First 101 robotic general surgery cases in a community hospital. JSLS. https://doi.org/10.4293/JSLS.2016.00056

    Article  PubMed  PubMed Central  Google Scholar 

  101. Al-Hathal N, El-Hakim A (2013) Perioperative, oncological and functional outcomes of the first robotic prostatectomy program in Quebec: single fellowship-trained surgeon’s experience of 250 cases. Can Urol Assoc J 7(9–10):326–332

    Article  PubMed  PubMed Central  Google Scholar 

  102. Philippou P, Waine E, Rowe E (2012) Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. J Endourol 26(8):1002–1008

    Article  PubMed  Google Scholar 

  103. Wagenhoffer R, Gruner M, Schymik J, Schachtner L, Neagoe L, Berg C et al (2015) Switching from endoscopic extraperitoneal radical prostatectomy to robot-assisted laparoscopic prostatectomy: comparing outcomes and complications. Urol Int 95(4):380–385

    Article  PubMed  Google Scholar 

  104. Schreuder HWR, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RHM (2012) Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG Int J Obstet Gynaecol 119(2):137–149

    Article  CAS  Google Scholar 

  105. Yao A, Iwamoto H, Masago T, Morizane S, Honda M, Sejima T et al (2015) Anatomical dimensions using preoperative magnetic resonance imaging: impact on the learning curve of robot-assisted laparoscopic prostatectomy. Int J Urol 22(1):74–79

    Article  PubMed  Google Scholar 

  106. Park S-S, Kim M-C, Park MS, Hyung WJ (2012) Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc 26(1):60–67

    Article  PubMed  Google Scholar 

  107. Bareeq RA, Jayaraman S, Kiaii B, Schlachta C, Denstedt JD, Pautler SE (2008) The role of surgical simulation and the learning curve in robot-assisted surgery. J Robot Surg 2(1):11–15

    Article  PubMed  Google Scholar 

  108. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  109. Macdonald AL, Haddad M, Clarke SA (2016) Learning curves in pediatric minimally invasive surgery: a systematic review of the literature and a framework for reporting. J Laparoendosc Adv Surg Tech A 26(8):652–659

    Article  PubMed  Google Scholar 

  110. Cook JA, Ramsay CR, Fayers P (2007) Using the literature to quantify the learning curve: a case study. Int J Technol Assess Health Care 23(2):255–260

    Article  PubMed  Google Scholar 

  111. Xu R, Carty MJ, Orgill DP, Lipsitz SR, Duclos A (2013) The teaming curve: a longitudinal study of the influence of surgical team familiarity on operative time. Ann Surg 258(6):953–957

    Article  PubMed  Google Scholar 

  112. Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R (2014) Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg 260(1):37–45

    Article  PubMed  Google Scholar 

  113. Noyez L (2013) Cumulative sum analysis: a simple and practical tool for monitoring and auditing clinical performance. Health Care Curr Rev 2(1):1–3

    Google Scholar 

  114. Kassite I et al (2018) The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multioutcome. approach. J Pediatr Urol. https://doi.org/10.1016/j.jpurol.2018.07.019

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatric Surgery Department, Gatien de Clocheville Hospital, University Teaching Hospital of Tours, 37000, Tours, France

    I. Kassite, H. Lardy & A. Binet

  2. Pharmacology Department, Bretonneau Hospital, University Teaching Hospital of Tours, 37000, Tours, France

    T. Bejan-Angoulvant

  3. Hopital Gatien de Clocheville - CHU de TOURS, 49, Boulevard Beranger, 37044, Tours, France

    I. Kassite

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  1. I. Kassite
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  2. T. Bejan-Angoulvant
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  3. H. Lardy
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  4. A. Binet
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Correspondence to I. Kassite.

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T. Bejan-Angoulvant, H. Lardy, A. Binet have no conflict of interest to declare related to the present work.

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Kassite, I., Bejan-Angoulvant, T., Lardy, H. et al. A systematic review of the learning curve in robotic surgery: range and heterogeneity. Surg Endosc 33, 353–365 (2019). https://doi.org/10.1007/s00464-018-6473-9

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  • DOI: https://doi.org/10.1007/s00464-018-6473-9

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