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Learning curve analysis of robot-assisted radical hysterectomy for cervical cancer: initial experience at a single institution

Authors
 Ga Won Yim  ;  Sang Wun Kim  ;  Eun Ji Nam  ;  Sunghoon Kim  ;  Young Tae Kim 
Citation
 JOURNAL OF GYNECOLOGIC ONCOLOGY, Vol.24(4) : 303-312, 2013 
Journal Title
JOURNAL OF GYNECOLOGIC ONCOLOGY
ISSN
 2005-0380 
Issue Date
2013
Keywords
Cervical neopla는 ; Laparoscopic surgery ; Learning curve ; Robotics
Abstract
OBJECTIVE:
The aim of this study was to evaluate the learning curve and perioperative outcomes of robot-assisted laparoscopic procedure for cervical cancer.
METHODS:
A series of 65 cases of robot-assisted laparoscopic radical hysterectomies with bilateral pelvic lymph node dissection for early stage cervical cancer were included. Demographic data and various perioperative parameters including docking time, console time, and total operative time were reviewed from the prospectively collected database. Console time was set as a surrogate marker for surgical competency, in addition to surgical outcomes. The learning curve was evaluated using cumulative summation method.
RESULTS:
The mean operative time was 190 minutes (range, 117 to 350 minutes). Two unique phases of the learning curve were derived using cumulative summation analysis; phase 1 (the initial learning curve of 28 cases), and phase 2 (the improvement phase of subsequent cases in which more challenging cases were managed). Docking and console times were significantly decreased after the first 28 cases compared with the latter cases (5 minutes vs. 4 minutes for docking time, 160 minutes vs. 134 minutes for console time; p<0.001 and p<0.001, respectively). There was a significant reduction in blood loss during operation (225 mL vs. 100 mL, p<0.001) and early postoperative complication rates (28% vs. 8.1%, p=0.003) in phase 2. No conversion to laparotomy occurred.
CONCLUSION:
Improvement of surgical performance in robot-assisted surgery for cervical cancer can be achieved after 28 cases. The two phases identified by cumulative summation analysis showed significant reduction in operative time, blood loss, and complication rates in the latter phase of learning curve.
Files in This Item:
T201303279.pdf Download
DOI
10.3802/jgo.2013.24.4.303
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Wun(김상운) ORCID logo https://orcid.org/0000-0002-8342-8701
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Young Tae(김영태) ORCID logo https://orcid.org/0000-0002-7347-1052
Nam, Eun Ji(남은지) ORCID logo https://orcid.org/0000-0003-0189-3560
Yim, Ga Won(임가원)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87942
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