TY - JOUR
T1 - Assessing the learning curve of robot-assisted total mesorectal excision
T2 - a multicenter study considering procedural safety, pathological safety, and efficiency
AU - Burghgraef, T. A.
AU - Sikkenk, D. J.
AU - Crolla, R. M. P. H.
AU - Fahim, M.
AU - Melenhorst, J.
AU - Moumni, M. El
AU - Schelling, G. van der
AU - Smits, A. B.
AU - Stassen, L. P. S.
AU - Verheijen, P. M.
AU - Consten, E. C. J.
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/1/11
Y1 - 2023/1/11
N2 - Purpose: Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision.Methods: A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. Results: In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve.Conclusion: The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.
AB - Purpose: Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision.Methods: A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. Results: In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve.Conclusion: The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.
KW - Learning curve
KW - Rectal cancer
KW - Robot-assisted surgery
KW - Total mesorectal excision
U2 - 10.1007/s00384-022-04303-7
DO - 10.1007/s00384-022-04303-7
M3 - Article
C2 - 36630001
AN - SCOPUS:85146138209
SN - 0179-1958
VL - 38
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
M1 - 9
ER -