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Learning curve for robotic-assisted laparoscopic rectal cancer surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

One of the main uses of robotic assisted abdominal surgery is the mesorectal excision in patients with rectal cancer. The aim of the present study is to analyse the learning curve for robotic assisted laparoscopic resection of rectal cancer.

Patients and methods

We included in our study 43 consecutive rectal cancer resections (16 females and 27 males) performed from January 2008 through December 2010. Mean age of patients was 66 ± 9.0 years. Surgical procedures included both abdomino-perineal and anterior resections. We analysed the following parameters: demographic data of the patients included in the study, intra- and postoperative data, time taking to set up the robot for operations (set-up or docking time), operative time, intra- and postoperative complications, conversion rates and pathological specimen features. The learning curve was analysed using cumulative sum (CUSUM) methodology.

Results

The procedures understudied included seven abdomino-perineal resections and 36 anterior resections. In our series of patients, mean robotic set-up time was 62.9 ± 24.6 min, and the mean operative time was 197.4 ± 44.3 min. Once we applied CUSUM methodology, we obtained two graphs for CUSUM values (operating time and success), both of them showing three well-differentiated phases: phase 1 (the initial 9–11 cases), phase 2 (the middle 12 cases) and phase 3 (the remaining 20–22 cases). Phase 1 represents initial learning; phase 2 plateau represents increased competence in the use of the robotic system, and finally, phase 3 represents the period of highest skill or mastery with a reduction in docking time (p = 0.000), but a slight increase in operative time (p = 0.007).

Conclusion

The CUSUM curve shows three phases in the learning and use of robotic assisted rectal cancer surgery which correspond to the phases of initial learning of the technique, consolidation and higher expertise or mastery. The data obtained suggest that the estimated learning curve for robotic assisted rectal cancer surgery is achieved after 21–23 cases.

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References

  1. Herold A, Lehur P, Matzel K, O’conell P (2008) Coloproctology (European Manual of Medicine), 1st edn. Springer, Berlin and Heidelberg GmbH & Co. K ed

  2. Miyajima N, Fukunaga M, Hasegawa H, Tanaka J, Okuda J, Watanabe M (2009) Results of a multicenter study of 1,057 cases of rectal cancer treated by laparoscopic surgery. Japan Society of Laparoscopic Colorectal Surgery. Surg Endosc 23:113–118

    Article  PubMed  Google Scholar 

  3. Liakakos T, Kopanakis K, Schizas D (2010) Favorable outcomes with laparoscopic surgery for rectal cancer. Surg Endosc 24:1217–1218

    Article  PubMed  CAS  Google Scholar 

  4. Staudacher C, Vignali A (2010) Laparoscopic surgery for rectal cancer: the state of the art. World J Gastrointest Surg 2:275–282

    Article  PubMed  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomized controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  6. Van de Paas MHGM, Te Velde EA, Cuesta MA, Bonjer HJ (2011) Favorable outcomes with laparoscopic surgery for rectal cancer. Surg Endosc 25(6):2060–2061. doi:10.1007/s00464-010-1457-4

    Article  Google Scholar 

  7. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH (2009) Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13:275–281

    Article  PubMed  Google Scholar 

  8. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed  Google Scholar 

  9. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 44:217–222

    Article  PubMed  CAS  Google Scholar 

  10. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, Lee IK, Chun CS (2010) Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A 20:609–617

    Article  PubMed  Google Scholar 

  11. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  PubMed  CAS  Google Scholar 

  12. Jiménez Rodríguez RM, Díaz Pavón JM, De la Portilla De Juan F, Prendes Sillero E, Cadet Dussort JMH, Padillo J (2011) Prospective, randomized, short-term outcome study: robotic-assisted laparoscopic surgery versus conventional laparosocpic surgery in colorectal carcinoma resection. Cir Esp 89:432–438

    Article  PubMed  Google Scholar 

  13. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case–control study. Dis Colon Rectum 54:151–156

    Article  PubMed  Google Scholar 

  14. Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J (2012) Robot-assisted total mesorrectal excisión: is there a learning curve? Surg Endosc. doi:10.1007/s00464-012-2216-5

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

    Article  PubMed  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, McKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  17. Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D, Mokart D, Houvenaeghel G, Giovannini M, Delpero JR (2010) The learning curve for the laparoscopic approach to conservative mesorrectal excision for rectal cancer. Lessons drawn from a single institution’s experience. Ann Surg 251:249–253

    Article  PubMed  Google Scholar 

  18. Son G, Kim J, Lee J, Suh Y, Cho H, Lee Y, Lee I, Chun C (2010) Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech 20:609–617

    Article  Google Scholar 

  19. Lim PC, Kang E, Park do H (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 120:413–418

    Article  PubMed  Google Scholar 

  20. Bell MC, Torgerson JL, Kreaden U (2009) The first 100 da Vinci hysterectomies: an analysis of the learning curve for a single surgeon. S D Med 62(91):93–95

    Google Scholar 

  21. Ou YC, Yang CR, Wang J, Cheng CL, Patel VR (2011) Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by a single surgeon. Asian J Surg 34:74–80

    Article  PubMed  Google Scholar 

  22. Ou YC, Yang CR, Wang J, Cheng CL, Patel VR (2010) Robotic-assisted laparoscopic radical prostatectomy: learning curve of first 100 cases. Int J Urol 17:635–640

    Article  PubMed  Google Scholar 

  23. Tekkis PP, Senagore AJ, Delaney CP (2005) Conversion rates in laparoscopic colorectal surgery: a predictive model with 1253 patients. Surg Endosc 19:47–54

    Article  PubMed  CAS  Google Scholar 

  24. Marusch F, Gastinger I, Schneider C et al (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44:207–214

    Article  PubMed  CAS  Google Scholar 

  25. Belizon A, Sardinha CT, Sher ME (2006) Converted laparoscopic colectomy: what are the consequences? Surg Endosc 20:947–951

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, University Hospital Virgen del Rocío, C/Jándula 2, Bl-3, P-3, 4º2, 41013, Sevilla, Spain

    Rosa M. Jiménez-Rodríguez, José Manuel Díaz-Pavón, Fernando de la Portilla de Juan, Emilio Prendes-Sillero, Hisnard Cadet Dussort & Javier Padillo

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  1. Rosa M. Jiménez-Rodríguez
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  2. José Manuel Díaz-Pavón
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  3. Fernando de la Portilla de Juan
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  4. Emilio Prendes-Sillero
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  5. Hisnard Cadet Dussort
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  6. Javier Padillo
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Corresponding author

Correspondence to Rosa M. Jiménez-Rodríguez.

Additional information

Robotic assisted rectal cancer surgery offers multiple advantages for surgeons, and it seems to yield the same clinical outcomes as regards the short-time follow-up of patients compared to conventional laparoscopy. The aim of the present study is to determine whether the learning curve for this surgical technique can be extrapolated to the well-known conventional laparoscopic technique or whether it enhances laparoscopic surgical performance offering further advantages.

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Jiménez-Rodríguez, R.M., Díaz-Pavón, J.M., de la Portilla de Juan, F. et al. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28, 815–821 (2013). https://doi.org/10.1007/s00384-012-1620-6

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  • DOI: https://doi.org/10.1007/s00384-012-1620-6

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