Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy
- Authors
- Kim, M.S.; Kim, W.J.; Hyung, W.J.; Kim, H.-I.; Han, S.-U.; Kim, Y.-W.; Ryu, K.W.; Park, S.
- Issue Date
- 5월-2021
- Publisher
- Lippincott Williams and Wilkins
- Keywords
- complication; learning curve; operation time; robotic gastrectomy; robotic surgery
- Citation
- Annals of Surgery, v.273, no.5, pp.949 - 956
- Indexed
- SCIE
SCOPUS
- Journal Title
- Annals of Surgery
- Volume
- 273
- Number
- 5
- Start Page
- 949
- End Page
- 956
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/128913
- DOI
- 10.1097/SLA.0000000000003583
- ISSN
- 0003-4932
- Abstract
- Objective: To evaluate the complication-based learning curve and identify learning-associated complications of robotic gastrectomy. Summary Background Data: With the increased popularity of robotic surgery, a sound understanding of the learning curve in the surgical outcome of robotic surgery has taken on great importance. However, a multicenter prospective study analyzing learning-associated morbidity has never been conducted in robotic gastrectomy. Methods: Data on 502 robotic gastrectomy cases were prospectively collected from 5 surgeons. Risk-adjusted cumulative sum analysis was applied to visualize the learning curve of robotic gastrectomy on operation time and complications. Results: Twenty-five cases, on average,were needed to overcome complications and operation time-learning curve sufficiently to gain proficiency in 3 surgeons. An additional 23 cases were needed to cross the transitional phase to progress from proficiency tomastery. The moderate complication rate (CD≥grade II) was 20% in phase 1 (cases 1-25), 10% in phase 2 (cases 26-65), 26.1% in phase 3 (cases 66-88), and 6.4% in phase 4 (cases 89-125) (P < 0.001). Among diverse complications, CD ≥ grade II intra-abdominal bleeding (P < 0.001) and abdominal pain (P = 0.01) were identified as major learning-associated morbidities of robotic gastrectomy. Previous experience on laparoscopic surgery and mode of training influenced progression in the learning curve. Conclusions: This is the first study suggesting that technical immaturity substantially affects the surgical outcomes of robotic gastrectomy and that robotic gastrectomy is a complex procedure with a significant learning curve that has implications for physician training and credentialing. © 2019 Wolters Kluwer Health, Inc.
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