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Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy

 Min Seo Kim  ;  Won Jun Kim  ;  Woo Jin Hyung  ;  Hyoung-Il Kim  ;  Sang-Uk Han  ;  Young-Woo Kim  ;  Keun Won Ryu  ;  Sungsoo Park 
 ANNALS OF SURGERY, Vol.273(5) : 949-956, 2021-05 
Journal Title
Issue Date
Education, Medical, Graduate / methods* ; Gastrectomy / education* ; Gastrectomy / methods ; Humans ; Laparoscopy / education* ; Laparoscopy / methods ; Learning Curve* ; Operative Time ; Prospective Studies ; Robotic Surgical Procedures / education* ; Robotic Surgical Procedures / methods ; Stomach Neoplasms / surgery ; Surgeons / education*
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 to mastery. 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.

Trial registration: ClinicalTrials.gov NCT01309256.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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