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.
| Original language | English |
|---|---|
| Journal | Annals of surgery |
| DOIs | |
| Publication status | Accepted/In press - 2019 Jan 1 |
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All Science Journal Classification (ASJC) codes
- Surgery
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Comprehensive Learning Curve of Robotic Surgery : Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy. / Kim, Min Seo; Kim, Won Jun; Hyung, Woo Jin; Kim, Hyoung Il; Han, Sang Uk; Kim, Young Woo; Ryu, Keun Won; Park, Sungsoo.
In: Annals of surgery, 01.01.2019.Research output: Contribution to journal › Article
TY - JOUR
T1 - Comprehensive Learning Curve of Robotic Surgery
T2 - Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy
AU - Kim, Min Seo
AU - Kim, Won Jun
AU - Hyung, Woo Jin
AU - Kim, Hyoung Il
AU - Han, Sang Uk
AU - Kim, Young Woo
AU - Ryu, Keun Won
AU - Park, Sungsoo
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85072060228&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003583
DO - 10.1097/SLA.0000000000003583
M3 - Article
C2 - 31503017
AN - SCOPUS:85072060228
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
ER -