Surgical Endoscopy

, Volume 26, Issue 9, pp 2471–2476 | Cite as

Robot-assisted total mesorectal excision: is there a learning curve?

  • Yasir Akmal
  • Jeong-Heum Baek
  • Shaun McKenzie
  • Julio Garcia-Aguilar
  • Alessio PigazziEmail author



Laparoscopic total mesorectal excision (TME) is associated with a steep learning curve, but the learning curve for robotic TME is unknown. This study aimed to evaluate the learning curve for robotic TME.


Between November 2004 and April 2009, 80 patients underwent robotic TME performed by a single surgeon. The operative experience was divided into two groups: group 1 (the first 40 cases) and group 2 (the subsequent 40 cases). Patient demographics, operative characteristics, and morbidities were compared.


The two patient populations selected did not differ statistically in age, body mass index (BMI), preoperative risk assessment, stage, preoperative chemoradiotherapy, or tumor location. The mean operative times in group 1 (310 min) and group 2 (297 min) were similar (p = 0.55), and the mean robotic TME time did not differ between the two groups (60 vs. 64 min; p = 0.65). In addition, the operative times did not improve during the course of the study. There were no differences in EBL, margin status, or number of lymph nodes harvested. Furthermore, there were no differences in conversion rate, time to resumption of diet, length of hospital stay, or postoperative complications.


Robot-assisted TME may attenuate the learning curve for laparoscopic rectal cancer resection. Further studies are necessary to establish the role of robotic surgery in minimally invasive rectal operations.


Learning curve Rectal cancer Robotic Total mesorectal excision 



Alessio Pigazzi acts as a consultant for Intuitive Surgical, Sunnyvale, CA. Yasir Akmal, Shaun McKenzie, Jeong-Heum Baek, and Julio Garcia-Aguilar have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Yasir Akmal
    • 1
  • Jeong-Heum Baek
    • 1
    • 2
  • Shaun McKenzie
    • 1
  • Julio Garcia-Aguilar
    • 1
  • Alessio Pigazzi
    • 1
    • 3
    Email author
  1. 1.Department of General and Oncologic SurgeryCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of SurgeryGachon University of Medicine and Science, Gil Medical CenterNamdong-gu, IncheonKorea
  3. 3.Division of Colon and Rectal SurgeryUniversity of CaliforniaIrvine, OrangeUSA

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