Skip to main content
SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopy offers some evidence of benefit compared to open rectal surgery. Robotic rectal surgery is evolving into an accepted approach. The objective was to analyze and compare laparoscopic and robotic rectal surgery learning curves with respect to operative times and perioperative outcomes for a novice minimally invasive colorectal surgeon.

Methods

One hundred and six laparoscopic and 92 robotic LAR rectal surgery cases were analyzed. All surgeries were performed by a surgeon who was primarily trained in open rectal surgery. Patient characteristics and perioperative outcomes were analyzed. Operative time and CUSUM plots were used for evaluating the learning curve for laparoscopic versus robotic LAR.

Results

Laparoscopic versus robotic LAR outcomes feature initial group operative times of 308 (291–325) min versus 397 (373–420) min and last group times of 220 (212–229) min versus 204 (196-211) min—reversed in favor of robotics; major complications of 4.7 versus 6.5 % (NS), resection margin involvement of 2.8 versus 4.4 % (NS), conversion rate of 3.8 versus 1.1 (NS), lymph node harvest of 16.3 versus 17.2 (NS), and estimated blood loss of 231 versus 201 cc (NS). Due to faster learning curves for extracorporeal phase and total mesorectal excision phase, the robotic surgery was observed to be faster than laparoscopic surgery after the initial 41 cases. CUSUM plots demonstrate acceptable perioperative surgical outcomes from the beginning of the study.

Conclusions

Initial robotic operative times improved with practice rapidly and eventually became faster than those for laparoscopy. Developing both laparoscopic and robotic skills simultaneously can provide acceptable perioperative outcomes in rectal surgery. It might be suggested that in the current milieu of clashing interests between evolving technology and economic constrains, there might be advantages in embracing both approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Larach SW, Salomon MC, Williamson PR, Goldstein E (1993) Laparoscopic assisted abdominoperineal resection. Surg Laparosc Endosc 3(2):115–118

    CAS  PubMed  Google Scholar 

  2. Chindasub S, Charntaracharmnong C, Nimitvanit C, Akkaranurukul P, Santitarmmanon B (1994) Laparoscopic abdominoperineal resection. J Laparoendosc Surg 4(1):17–21

    Article  CAS  PubMed  Google Scholar 

  3. Darzi A, Lewis C, Menzies Gow N, Guillou PJ, Monson JR (1995) Laparoscopic abdominoperineal excision of the rectum. Surg Endosc 9(4):414–417

    Article  CAS  PubMed  Google Scholar 

  4. Ramos JR, Petrosemolo RH, Valory EA, Polania FC, Pecanha R (1997) Abdominoperineal resection: laparoscopic versus conventional. Surg Laparosc Endosc 7(2):148–152

    Article  CAS  PubMed  Google Scholar 

  5. Iroatulam AJ, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD (1998) Laparoscopic abdominoperineal resection for anorectal cancer. Am Surg 64(1):12–18

    CAS  PubMed  Google Scholar 

  6. Fleshman JW, Wexner SD, Anvari M, La Tulippe JF, Birnbaum EH, Kodner IJ et al (1999) Laparoscopic versus open abdominoperineal resection for cancer. Dis Colon Rectum 42(7):930–939

    Article  CAS  PubMed  Google Scholar 

  7. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250(1):54–61

    Article  PubMed  Google Scholar 

  8. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645

    Article  CAS  PubMed  Google Scholar 

  9. Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gullà N, Giustozzi G, Sciannameo F, Noya G, Boselli C (2012) Laparoscopic versus open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 14(6):277–296

    Article  Google Scholar 

  10. Baik SH, Kwon HY, Kim JS et al (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16(6):1480–1487

    Article  PubMed  Google Scholar 

  11. Mirnezami AH, Mirnezami R, Venkatasubramaniam AK et al (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12(11):1084–1093

    Article  CAS  PubMed  Google Scholar 

  12. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13(2):176–183

    PubMed Central  PubMed  Google Scholar 

  13. Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24(11):2888–2894

    Article  CAS  PubMed  Google Scholar 

  14. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17(12):3195–3202

    Article  PubMed  Google Scholar 

  15. Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A (2010) Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 251(5):882–886

    Article  PubMed  Google Scholar 

  16. Kim JY, Kim NK, Lee KY, Huh H, Min BS, Kim JW (2012) A comparative study of voiding and sexual function after Total Mesenteric excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493

    Article  PubMed  Google Scholar 

  17. Baek JH, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525

    Article  PubMed  Google Scholar 

  18. Kim NK, Kang J (2010) Optimal total mesorectal excision for ectal cancer: the role of robotic surgery from an expert’s view. J Korean Soc Coloproctology 26:377–387

    Article  PubMed Central  Google Scholar 

  19. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  20. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708

    Article  CAS  PubMed  Google Scholar 

  21. Hommel G, Röhrig B, Blettner M (2009) Confidence Interval or P-Value? Dtsch Arztebl Int 106(19):335–339

    PubMed Central  PubMed  Google Scholar 

  22. Lim TO, Soraya A, Ding LM, Morad Z (2002) Assessing doctors’ competence: application of CUSUM technique in monitoring doctor’s performance. Int J Qual Health Care 14(3):251–258

    Article  CAS  PubMed  Google Scholar 

  23. Colquhoun PHD (2008) CUSUM analysis of J-pouch surgery reflects no learning curve after board certification. Can J Surg 51(4):296–299

    PubMed Central  PubMed  Google Scholar 

  24. 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 Central  PubMed  Google Scholar 

  25. Taflampas P, Christodoulakis M, Tsiftis DD (2009) Anastomotic Leakage after low anterior resection for rectal cancer: facts, obscurity, and fiction. Surg Today 39:183–188

    Article  PubMed  Google Scholar 

  26. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13(3):413–424

    Article  PubMed  Google Scholar 

  27. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312

    Article  PubMed  Google Scholar 

  28. Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51(11):1627–1632

    Article  PubMed  Google Scholar 

  29. Hellan CM, Anderson C, Ellenhorn JDI, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14(11):3168–3173

    Article  PubMed  Google Scholar 

  30. Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Robot-assisted total mesorectal excision: is there a learning curve? Surg Endosc 2012; Surg Endosc. 2012 Mar 22 [Epub ahead of print],PMID: 22437950

  31. Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N (2011) Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 25:2972–2979

    Article  PubMed  Google Scholar 

  32. Stefanidis D, Wang F, Korndorffer JR, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24(2):377–382

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

We would like to express our gratitude to Mr. Martin Morris, Librarian, Medical Library, Royal Victoria Hospital, McGill University, Montreal, Canada for assistance with literature search and Mrs. Myo Jeong Kim, MS with Dr. Dong Wook Kim, PhD from the Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea for their help with statistical analysis. We also acknowledge and appreciate editing services of Mr. Shaun Fawcett of Final Draft Consulting, Montreal.

Disclosure

Drs. George Melich, Young Ki Hong, Jieun, Kim, and Sender Liberman have no conflicts of interest or financial ties to disclose. Drs. Hyuk Hur MD, Seung Hyuk Baik, Nam Kyu Kim, and Byung Soh Min have received in the past travel and speaking honoraria from Intuitive Surgical.

Author information

Authors and Affiliations

  1. Department of Surgery, McGill University, Montreal, Canada

    George Melich & A. Sender Liberman

  2. Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

    Young Ki Hong

  3. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea

    Jieun Kim

  4. Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea

    Hyuk Hur, Seung Hyuk Baik, Nam Kyu Kim & Byung Soh Min

Authors
  1. George Melich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Ki Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jieun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyuk Hur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seung Hyuk Baik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nam Kyu Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Sender Liberman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Byung Soh Min
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Byung Soh Min.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Melich, G., Hong, Y.K., Kim, J. et al. 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, 558–568 (2015). https://doi.org/10.1007/s00464-014-3698-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3698-0

Keywords

Search

Navigation