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Learning curve of robotic rectal surgery using risk-adjusted cumulative summation: a 5-year institutional experience

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Abstract

Purpose

Outline learning phases of robot-assisted laparoscopic surgery for rectal cancer and compare surgical and clinical outcomes between each phase of robot-assisted laparoscopic surgery and the mastery phase of conventional laparoscopic surgery.

Methods

From 2015 to 2020, 210 patients underwent rectal cancer surgery at Sendai Medical Center. We performed conventional laparoscopic surgery in 110 patients and, laparoscopic surgery in 100 patients. The learning curve was evaluated using the cumulative summation method, risk-adjusted cumulative summation method, and logistic regression analysis.

Results

The risk-adjusted cumulative summation learning curve was divided into three phases: phase 1 (cases 1–48), phase 2 (cases 49–80), and phase 3 (cases 81–100). Duration of hospital stay (13.1 days vs. 18.0 days, respectively; p = 0.016) and surgery (209.1 min vs. 249.5 min, respectively; p = 0.045) were significantly shorter in phase 3 of the robot-assisted laparoscopic surgery group than in the conventional laparoscopic surgery group. Blood loss volume was significantly lower in phase 1 of the robot-assisted laparoscopic surgery group than in the conventional laparoscopic surgery group (17.7 ml vs. 79.7 ml, respectively; p = 0.036). The International Prostate Symptom Score was significantly lower in the robot-assisted laparoscopic surgery group (p = 0.0131).

Conclusions

Robot-assisted laparoscopic surgery for rectal cancer was safe and demonstrated better surgical and clinical outcomes, including a shorter hospital stay, less blood loss, and a shorter surgical duration, than conventional laparoscopic surgery. After experience with at least 80 cases, tactile familiarity can be acquired from visual information only (visual haptic feedback).

Clinical trial registration

UMIN reference no. UMIN000019857.

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Data availability

Data can be made available on request.

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Acknowledgements

We thank Kazunori Takeda for designing the study. We thank Emily Woodhouse, PhD, and Leah Cannon, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery I, Yamagata University Hospital, 2-2-2 IidanishiYamagata Prefecture, Yamagata, 990-9585, Japan

    Hiroshi Oshio, Shinji Okazaki, Ichiro Kawamura, Yuya Ashitomi, Masaaki Kawai, Hiroaki Musha & Fuyuhiko Motoi

  2. Department of Surgery, Sendai Medical Center, 2-11-12 Miyagino, Miyagino-Ku, Sendai, Miyagi Prefecture, 983-8520, Japan

    Hiroshi Oshio, Yukiko Oshima & Gen Yunome

  3. Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata Prefecture, Yamagata, 990-9585, Japan

    Tsuneo Konta

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Contributions

H.O., Y.O., and G.Y. substantially contributed to the study conceptualization. T.K. and F.M. significantly contributed to data analysis and interpretation. F.M. substantially contributed to the manuscript drafting. All authors critically reviewed and revised the manuscript draft and approved the final version for submission.

Corresponding author

Correspondence to Fuyuhiko Motoi.

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Competing interests

The authors declare no competing interests.

Ethics approval

The study protocol was approved by the local ethics committees of Sendai Medical Center (reference number: 27–8). The research was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments.

Patient consent

Informed consent was obtained from all patients.

Conflict of interest

The authors declare no competing interests.

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Oshio, H., Konta, T., Oshima, Y. et al. Learning curve of robotic rectal surgery using risk-adjusted cumulative summation: a 5-year institutional experience. Langenbecks Arch Surg 408, 89 (2023). https://doi.org/10.1007/s00423-023-02829-0

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