Authors: Manfred Odermatt Jamil Ahmed Sofoklis Panteleimonitis Jim Khan Amjad Parvaiz
Publish Date: 2017/03/07
Volume: 31, Issue: 10, Pages: 4067-4076
Abstract
The learning curve for robotic colorectal surgery is illdefined This study aimed to investigate the learning curve of experienced laparoscopic rectal surgeons when starting with robotic total mesorectal excision TME using cumulative sum CUSUM chartsThis retrospective case series analysed patients who underwent curative and elective laparoscopic or robotic TMEs for rectal cancer performed by two surgeons The first consecutive robotic TME cases of each surgeon were 11 propensity score matched to their laparoscopic TME cases using age body mass index American Society of Anesthesiologists grade T stage AJCC and tumour location height The matched laparoscopic cases defined individual standards for the quality indicators operating time R stage lymph node harvest length of hospital stay and major complications Clavien–Dindo grade 3–5 Deviation of more than a quarter of a standard deviation from the mean for the continuous indicators or exceeding the observed risk for the binary indicators was defined as offtarget with an upward inflection in the CUSUM curveFrom 2006 to 2015 384 294 laparoscopic 90 robotic TMEs met the inclusion criteria Surgeon A performed 206 701 of the laparoscopic and 43 478 of the robotic cases Surgeon B performed 88 299 of the laparoscopic and 47 522 of the robotic cases After matching no covariate exhibited an absolute standardised mean difference 025 For surgeon A the CUSUM curves showed no apparent learning process compared to his laparoscopic standards For surgeon B a learning process for operation time lymph node harvest and major complications was demonstrated by an initial upward inflection of the CUSUM curves after 15 cases all quality indicators were generally on target
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