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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Aziz O et al (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424

    Article  PubMed  Google Scholar 

  2. Barlehner E et al (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19:757–766

    Article  PubMed  CAS  Google Scholar 

  3. Bretagnol F et al (2005) The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 19:892–896

    Article  PubMed  CAS  Google Scholar 

  4. Dulucq JL et al (2005) Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 19:1468–1474

    Article  PubMed  Google Scholar 

  5. Hartley JE et al (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44:315–321

    Article  PubMed  CAS  Google Scholar 

  6. Jayne DG et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  7. Leroy J et al (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289

    Article  PubMed  CAS  Google Scholar 

  8. Morino M et al (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19:1460–1467

    Article  PubMed  CAS  Google Scholar 

  9. Morino M et al (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342

    PubMed  Google Scholar 

  10. Hellan M et al (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173

    Article  PubMed  Google Scholar 

  11. Pigazzi A et al (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. Purkayastha S et al (2004) Does laparoscopic surgery offer adequate clearance in rectal cancer? A discussion. Int J Surg 2:103–106

    Article  PubMed  CAS  Google Scholar 

  13. Rockall TA, Darzi A (2003) Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 83:1463–1468 Xi

    Article  PubMed  Google Scholar 

  14. Delaney CP et al (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  15. Hance J, Rockall T, Darzi A (2004) Robotics in colorectal surgery. Dig Surg 21:339–343

    Article  PubMed  CAS  Google Scholar 

  16. Prasad SM et al (2002) The effect of robotic assistance on learning curves for basic laparoscopic skills. Am J Surg 183:702–707

    Article  PubMed  Google Scholar 

  17. Vibert E, Denet C, Gayet B (2003) Major digestive surgery using a remote-controlled robot: the next revolution. Arch Surg 138:1002–1006

    Article  PubMed  Google Scholar 

  18. Weber PA et al (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694 discussion 1695–1696

    Article  PubMed  Google Scholar 

  19. Pruthi RS, Smith A, Wallen EM (2008) Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy. J Endourol 22:2469–2474

    Article  PubMed  Google Scholar 

  20. Heald RJ (1995) Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Br J Surg 82:1297–1299

    Article  PubMed  CAS  Google Scholar 

  21. Heald RJ et al (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899

    Article  PubMed  CAS  Google Scholar 

  22. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  PubMed  CAS  Google Scholar 

  23. Heald RJ, Ryall RD (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  24. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124

    Article  PubMed  CAS  Google Scholar 

  25. Guillou PJ et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  26. Lacy AM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  27. Veldkamp R et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  28. Agachan F et al (1997) Laparoscopic colorectal surgery: do we get faster? Surg Endosc 11:331–335

    Article  PubMed  CAS  Google Scholar 

  29. Park IJ et al (2009) Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1,000 cases of laparoscopic colorectal surgery. Surg Endosc 23:839–846

    Article  PubMed  Google Scholar 

  30. Reissman P et al (1996) Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 20:277–281 discussion 282

    Article  PubMed  CAS  Google Scholar 

  31. Schlachta CM et al (2000) Determinants of outcomes in laparoscopic colorectal surgery: a multiple regression analysis of 416 resections. Surg Endosc 14:258–263

    Article  PubMed  CAS  Google Scholar 

  32. Senagore AJ, Luchtefeld MA, Mackeigan JM (1995) What is the learning curve for laparoscopic colectomy? Am Surg 61:681–685

    PubMed  CAS  Google Scholar 

  33. Simons AJ et al (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38:600–603

    Article  PubMed  CAS  Google Scholar 

  34. Tekkis PP et al (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 

  35. Ito M et al (2009) Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23:403–408

    Article  PubMed  Google Scholar 

  36. Leung KL et al (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192

    Article  PubMed  Google Scholar 

  37. Menon M et al (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168:945–949

    Article  PubMed  Google Scholar 

  38. Ahlering TE et al (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741

    Article  PubMed  Google Scholar 

  39. Hanisch E, Ziogas D (2009) Beyond quality-of-life improvement: how robotic surgery for low anterior resection with total mesorectal excision also may improve oncologic outcomes. Surg Endosc 23:2662–2664

    Article  PubMed  CAS  Google Scholar 

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Disclosures

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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Author notes

  1. Alessio Pigazzi

    Present address: Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA

Authors and Affiliations

  1. Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Yasir Akmal, Jeong-Heum Baek, Shaun McKenzie, Julio Garcia-Aguilar & Alessio Pigazzi

  2. Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea

    Jeong-Heum Baek

Authors
  1. Yasir Akmal
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  2. Jeong-Heum Baek
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  4. Julio Garcia-Aguilar
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  5. Alessio Pigazzi
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Correspondence to Alessio Pigazzi.

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Akmal, Y., Baek, JH., McKenzie, S. et al. Robot-assisted total mesorectal excision: is there a learning curve?. Surg Endosc 26, 2471–2476 (2012). https://doi.org/10.1007/s00464-012-2216-5

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  • DOI: https://doi.org/10.1007/s00464-012-2216-5

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