Surgical Endoscopy

, Volume 26, Issue 4, pp 1116–1121 | Cite as

Learning curve for robot-assisted Roux-en-Y gastric bypass

  • Nicolas C. Buchs
  • François Pugin
  • Pascal Bucher
  • Monika E. Hagen
  • Gilles Chassot
  • Pascale Koutny-Fong
  • Philippe Morel



Robot-assisted Roux-en-Y gastric bypass (RYGBP) is rapidly evolving as an important surgical approach in the bariatric field. However, the specific learning curve associated with this new approach remains poorly investigated. This study aimed to evaluate the learning curve for robot-assisted RYGBP.


A series of 64 consecutive robot-assisted RYGBP procedures were performed between December 2008 and December 2010 by a single surgeon already experienced in advanced laparoscopic procedures but not in bariatric surgery. All data were collected prospectively in a database and reviewed retrospectively. The learning curve was evaluated using the cumulative sum (CUSUM) method.


Women comprised 76.6% and men 23.4% of this series. These patients had a mean age of 43 years and a mean body mass index (BMI) of 44.5 kg/m2. The mean operative time (OT) was 238.1 min (range, 150–400 min). A total of six complications occurred (9.4%). The CUSUM learning curve consisted of two distinct phases: phase 1 (the initial 14 cases; mean OT, 288.9 min) and phase 2 (the subsequent cases; mean OT, 223.6 min), which represented the mastery phase, with a decrease in OT (P = 0.0001). The two groups were similar in terms of gender, age, and BMI. The two phases did not differ in terms of complications or hospital stay.


This series confirms previous study findings concerning the feasibility and the safety of robotic RYGBP even after a limited experience with laparoscopic RYGBP. The data reported in this article suggest that the learning phase for robot-assisted RYGBP can be achieved with 14 cases.


Complications CUSUM Da Vinci Gastric bypass Learning curve Operative Robotic time 



Monika E. Hagen is a part-time consultant for Intuitive Surgical Inc. Nicolas C. Buchs, François Pugin, Pascal Bucher, Gilles Chassot, Pascale Koutny-Fong, and Philippe Morel have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Nicolas C. Buchs
    • 1
  • François Pugin
    • 1
  • Pascal Bucher
    • 1
  • Monika E. Hagen
    • 1
  • Gilles Chassot
    • 1
  • Pascale Koutny-Fong
    • 1
  • Philippe Morel
    • 1
  1. 1.Clinic for Visceral and Transplantation Surgery, Department of SurgeryUniversity Hospital of GenevaGeneva 14Switzerland

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