Learning curve in robotic liver surgery: easily achievable, evolving from laparoscopic background and team-based.

HPB (Oxford)

Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy; University Vita-Salute San Raffaele, Faculty of Medicine, 20132, Milan, Italy.

Published: October 2024

AI Article Synopsis

  • - The study focused on evaluating the learning curves of two surgeons with different laparoscopic experiences performing robotic liver resections at San Raffaele Hospital, using cumulative sum (CUSUM) analysis on surgeries performed since February 2021.
  • - Results indicated that both surgeons improved their operative times after performing a set number of cases, with the Pioneer Surgeon and New Generation Surgeon needing 15 and 10 low- to intermediate-complexity cases respectively, and 10 and 18 high-complexity cases.
  • - The findings highlight that team collaboration significantly impacts the learning process, revealing that after 12 cases, a "team learning curve" was evident, showing the effectiveness of working together in surgical settings.

Article Abstract

Background: Limited and heterogeneous literature data necessitate a focused examination of the learning curve in robotic liver resections. This study aims to assess the learning curve of two surgeons from the same team with differing laparoscopic backgrounds.

Methods: Since February 2021, San Raffaele Hospital in Milan has implemented a robotic liver surgery program, performing 250 resections by three trained console surgeons. Using cumulative sum (CUSUM) analysis, the learning curve was evaluated for a Pioneer Surgeon (PS) with around 1200 laparoscopic cases and a New Generation Surgeon (NGS) with approximately 100 laparoscopic cases. Cases were stratified by complexity (38 low, 74 intermediate, 85 high).

Results: Both PS and NGS demonstrated a learning curve for operative time after 15 low-complexity and 10 intermediate-complexity cases, with high-complexity learning curves apparent after 10 cases for PS and 18 cases for NGS. Conversion rates remained unaffected, and neither surgeon experienced increased blood loss or postoperative complications. A "team learning curve" effect in terms of operative time emerged after 12 cases, suggesting the importance of a cohesive surgical team.

Conclusion: The robotic platform facilitated a relatively brief learning curve for low and intermediate complexity cases, irrespective of laparoscopic background, underscoring the benefits of team collaboration.

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Source
http://dx.doi.org/10.1016/j.hpb.2024.10.007DOI Listing

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