IMPORTANCE: Robotic colorectal resection continues to gain in popularity. However, limited data are available regarding how surgeons gain competency and institutions develop programs. OBJECTIVE: To determine the number of cases required for establishing a robotic colorectal cancer surgery program. DESIGN: Retrospective review. SETTING: Cancer center. PATIENTS: We reviewed 418 robotic-assisted resections for colorectal adenocarcinoma from January 1, 2009, to December 31, 2014, by surgeons at a single institution. The individual surgeon's and institutional learning curve were examined. The earliest adopter, Surgeon 1, had the highest volume. Surgeons 2-4 were later adopters. Surgeon 5 joined the group with robotic experience. INTERVENTIONS: A cumulative summation technique (CUSUM) was used to construct learning curves and define the number of cases required for the initial learning phase. Perioperative variables were analyzed across learning phases. MAIN OUTCOME MEASURE: Case numbers for each stage of the learning curve. RESULTS: The earliest adopter, Surgeon 1, performed 203 cases. CUSUM analysis of surgeons' experience defined three learning phases, the first requiring 74 cases. Later adopters required 23-30 cases for their initial learning phase. For Surgeon 1, operative time decreased from 250 to 213.6 min from phase 1-3 (P = 0.008), with no significant changes in intraoperative complication or leak rate. For Surgeons 2-4, operative time decreased from 418 to 361.9 min across the two phases (P = 0.004). Their intraoperative complication rate decreased from 7.8 to 0 % (P = 0.03); the leak rate was not significantly different (9.1 vs. 1.5 %, P = 0.07), though it may be underpowered given the small number of events. CONCLUSIONS: Our data suggest that establishing a robotic colorectal cancer surgery program requires approximately 75 cases. Once a program is well established, the learning curve is shorter and surgeons require fewer cases (25-30) to reach proficiency. These data suggest that the institutional learning curve extends beyond a single surgeon's learning experience.
IMPORTANCE: Robotic colorectal resection continues to gain in popularity. However, limited data are available regarding how surgeons gain competency and institutions develop programs. OBJECTIVE: To determine the number of cases required for establishing a robotic colorectal cancer surgery program. DESIGN: Retrospective review. SETTING:Cancer center. PATIENTS: We reviewed 418 robotic-assisted resections for colorectal adenocarcinoma from January 1, 2009, to December 31, 2014, by surgeons at a single institution. The individual surgeon's and institutional learning curve were examined. The earliest adopter, Surgeon 1, had the highest volume. Surgeons 2-4 were later adopters. Surgeon 5 joined the group with robotic experience. INTERVENTIONS: A cumulative summation technique (CUSUM) was used to construct learning curves and define the number of cases required for the initial learning phase. Perioperative variables were analyzed across learning phases. MAIN OUTCOME MEASURE: Case numbers for each stage of the learning curve. RESULTS: The earliest adopter, Surgeon 1, performed 203 cases. CUSUM analysis of surgeons' experience defined three learning phases, the first requiring 74 cases. Later adopters required 23-30 cases for their initial learning phase. For Surgeon 1, operative time decreased from 250 to 213.6 min from phase 1-3 (P = 0.008), with no significant changes in intraoperative complication or leak rate. For Surgeons 2-4, operative time decreased from 418 to 361.9 min across the two phases (P = 0.004). Their intraoperative complication rate decreased from 7.8 to 0 % (P = 0.03); the leak rate was not significantly different (9.1 vs. 1.5 %, P = 0.07), though it may be underpowered given the small number of events. CONCLUSIONS: Our data suggest that establishing a robotic colorectal cancer surgery program requires approximately 75 cases. Once a program is well established, the learning curve is shorter and surgeons require fewer cases (25-30) to reach proficiency. These data suggest that the institutional learning curve extends beyond a single surgeon's learning experience.
Authors: Evie Carchman; Daniel I Chu; Gregory D Kennedy; Melanie Morris; Marc Dakermandji; John R T Monson; Laura Melina Fernandez; Rodrigo Oliva Perez; Alessandro Fichera; Marco E Allaix; David Liska Journal: J Gastrointest Surg Date: 2018-09-13 Impact factor: 3.452
Authors: C S D Roxburgh; P Strombom; P Lynn; A Cercek; M Gonen; J J Smith; L K F Temple; G M Nash; J G Guillem; P B Paty; J Shia; E Vakiani; R Yaeger; Z K Stadler; N H Segal; D Reidy; A Varghese; A J Wu; C H Crane; M J Gollub; L B Saltz; J Garcia-Aguilar; M R Weiser Journal: Colorectal Dis Date: 2019-07-01 Impact factor: 3.788
Authors: William B Lyman; Michael J Passeri; Keith Murphy; Imran A Siddiqui; Adeel S Khan; David A Iannitti; John B Martinie; Erin H Baker; Dionisios Vrochides Journal: Surg Endosc Date: 2020-06-16 Impact factor: 4.584
Authors: J C Bolger; M P Broe; M A Zarog; A Looney; K McKevitt; D Walsh; S Giri; C Peirce; J C Coffey Journal: Tech Coloproctol Date: 2017-09-19 Impact factor: 3.781
Authors: E Duchalais; N Machairas; S R Kelley; R G Landmann; A Merchea; D T Colibaseanu; K L Mathis; E J Dozois; D W Larson Journal: Surg Endosc Date: 2018-03-15 Impact factor: 4.584
Authors: Vejay N Vakharia; Roman Rodionov; Andrew W McEvoy; Anna Miserocchi; Rachel Sparks; Aidan G O'Keeffe; Sebastien Ourselin; John S Duncan Journal: J Neurosurg Date: 2018-02-16 Impact factor: 5.115