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Journal of Robotic Surgery (2023) 17:73–78
https://doi.org/10.1007/s11701-022-01400-1
ORIGINAL ARTICLE
The robotic learning curve foranewly appointed colorectal surgeon
SabahUddinSaqib1 · MuhammadZeeshanRaza2· CharlesEvans3· AdeelAhmadBajwa3
Received: 3 February 2022 / Accepted: 11 March 2022 / Published online: 24 March 2022
© Crown 2022
Abstract
Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of
the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies.
However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formal-
ized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and
effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics
related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in
the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a
recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console
and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related
outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve.
Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were
divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of
the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3
to 2.5h, while total operative time dropped from 6h to 5.5h as the surgeon became more experienced; however, this was
not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study
period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after
30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for
robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are
low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new
colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.
Keywords Robotic surgery· Da Vinci· Learning curve· Colorectal cancer
Abbreviations
CRC Colorectal cancer
CRM Circumferential resection margin
LOS Length of stay
rELAPE Robotic extra levator abdominoperineal
excision
rAR Robotic anterior resection
rLAR Robotic lower anterior resection
TME Total mesorectal excision
Introduction
Robotic surgery has expanded the potential of minimally
invasive surgery through articulated instrumentation giving
the freedom of movement to replicate open surgery. These
* Sabah Uddin Saqib
Sabah.saqib@uhcw.nhs.uk
Muhammad Zeeshan Raza
zraza1991@gmail.com
Charles Evans
Charles.Evans@uhcw.nhs.uk
Adeel Ahmad Bajwa
AdeelAhmad.Bajwa@uhcw.nhs.uk
1 Clinical Fellow Colorectal Surgery, University Hospital
Coventry, Coventry, UK
2 Robotic Research Fellow inRobotic Colorectal Surgery,
University Hospital Coventry, Coventry, UK
3 Consultant Colorectal Surgeon, University Hospital
Coventry, Coventry, UK
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