Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre
Background: Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. Due to rapid adoption of robotics in rectal surgery, we intended to assess the pace in which surgeons gain proficiency using cumulative summation (CUSUM) technique in l...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Minimal Access Surgery |
| Subjects: | |
| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=4;spage=466;epage=472;aulast=Somashekhar |
| _version_ | 1797231821865353216 |
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| author | S P Somashekhar Elroy Saldanha Kalyan Pandey Rohit Kumar K R Ashwin |
| author_facet | S P Somashekhar Elroy Saldanha Kalyan Pandey Rohit Kumar K R Ashwin |
| author_sort | S P Somashekhar |
| collection | DOAJ |
| description | Background: Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. Due to rapid adoption of robotics in rectal surgery, we intended to assess the pace in which surgeons gain proficiency using cumulative summation (CUSUM) technique in learning curve.
Materials and Methods: This was a prospective study of 262 rectal cancer cases who underwent robotic-assisted low anterior resection and abdominoperineal resection (RA-LAR and RA-APR). Parameters considered for the study were console time, docking time, lymph nodal yield, total operative time and post-operative outcomes. We used Manipal technique of port placements and modified centroside docking for the procedure.
Results: The mean age of our study was 46.62 ± 5.7 years, the mean body mass index (BMI) was 31.51 ± 3.2 kg/m2. 215 (82.06%) underwent RA-LAR and 47 (17.93%) underwent RA-APR. 2.67% of cases required to open during our initial period. We had three phases of learning curve, initial phase (11th case), plateau phase (29th case) and then phases of mastery (30th case onwards). Our mean total operative time reduced from 5.5 to 3.5 h (210 ± 8.2 min), console time from 4.5 to 2.9 h (174 ± 4.5 min) and docking time from 15 to 9 ± 1 min from 30th case onwards.
Conclusion: RA surgeries for rectal cancer have got good oncological and functional outcomes in high BMI, male pelvis and low rectal cancers. Learning curve can be shortened with constant self-auditing of the surgeon and team with each surgeries performed, reviewing the steps and by improving techniques. |
| first_indexed | 2024-04-24T15:50:29Z |
| format | Article |
| id | doaj.art-922e11ef79614971a527bd6a101cc80a |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-04-24T15:50:29Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-922e11ef79614971a527bd6a101cc80a2024-04-01T12:50:14ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212023-01-0119446647210.4103/jmas.jmas_114_22Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centreS P SomashekharElroy SaldanhaKalyan PandeyRohit KumarK R AshwinBackground: Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. Due to rapid adoption of robotics in rectal surgery, we intended to assess the pace in which surgeons gain proficiency using cumulative summation (CUSUM) technique in learning curve. Materials and Methods: This was a prospective study of 262 rectal cancer cases who underwent robotic-assisted low anterior resection and abdominoperineal resection (RA-LAR and RA-APR). Parameters considered for the study were console time, docking time, lymph nodal yield, total operative time and post-operative outcomes. We used Manipal technique of port placements and modified centroside docking for the procedure. Results: The mean age of our study was 46.62 ± 5.7 years, the mean body mass index (BMI) was 31.51 ± 3.2 kg/m2. 215 (82.06%) underwent RA-LAR and 47 (17.93%) underwent RA-APR. 2.67% of cases required to open during our initial period. We had three phases of learning curve, initial phase (11th case), plateau phase (29th case) and then phases of mastery (30th case onwards). Our mean total operative time reduced from 5.5 to 3.5 h (210 ± 8.2 min), console time from 4.5 to 2.9 h (174 ± 4.5 min) and docking time from 15 to 9 ± 1 min from 30th case onwards. Conclusion: RA surgeries for rectal cancer have got good oncological and functional outcomes in high BMI, male pelvis and low rectal cancers. Learning curve can be shortened with constant self-auditing of the surgeon and team with each surgeries performed, reviewing the steps and by improving techniques.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=4;spage=466;epage=472;aulast=Somashekharconsole timecumulation summation techniquedocking timerobotic-assisted abdominoperineal resectionrobotic-assisted low anterior resectiontotal operative time |
| spellingShingle | S P Somashekhar Elroy Saldanha Kalyan Pandey Rohit Kumar K R Ashwin Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre Journal of Minimal Access Surgery console time cumulation summation technique docking time robotic-assisted abdominoperineal resection robotic-assisted low anterior resection total operative time |
| title | Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre |
| title_full | Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre |
| title_fullStr | Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre |
| title_full_unstemmed | Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre |
| title_short | Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre |
| title_sort | prospective analysis of impact of learning curve in robotic assisted rectal surgery in the high volume indian tertiary care centre |
| topic | console time cumulation summation technique docking time robotic-assisted abdominoperineal resection robotic-assisted low anterior resection total operative time |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=4;spage=466;epage=472;aulast=Somashekhar |
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