Skip to main content
Top
Published in: Current Urology Reports 11/2017

01-11-2017 | Urosurgery (P Sooriakumaran, Section Editor)

Learning Curves for Robotic Surgery: a Review of the Recent Literature

Authors: Giorgio Mazzon, Ashwin Sridhar, Gerald Busuttil, James Thompson, Senthil Nathan, Tim Briggs, John Kelly, Greg Shaw

Published in: Current Urology Reports | Issue 11/2017

Login to get access

Abstract

Use of robot-assisted surgery is increasing since its advent in the 1990s. Robotic surgical training is the subject of much interest. Robotic technology would seem to facilitate training allowing more rapid attainment of competence. The safety and success of a particular surgical team depends on adequacy of training of its members. A learning curve is a way of describing the changes observed in surgical outcomes with increasing experience of the surgeon and can be used to plan training programs. The majority of published papers regarding learning curves are retrospective with small numbers of surgeons with different levels of experience comparing a variety of different outcomes. In this review, we describe the published literature on learning curves in robotic urological surgery, with the aim of offering a guide to both experienced and naïve surgeons who plan to learn new robotic procedure.
Literature
1.
go back to reference Herrel SD, Smith JA. Robotic –assisted laparoscopic prostatectomy: what is the learning curve? Urology. 2005;66(5 Suppl):105–7.CrossRef Herrel SD, Smith JA. Robotic –assisted laparoscopic prostatectomy: what is the learning curve? Urology. 2005;66(5 Suppl):105–7.CrossRef
2.
go back to reference Artibani W, Novara G. Cancer-related outcome and learning curve in retropubic radical prostatectomy: if you need an operation, the most important step is to choose the right surgeon. Eur Urol. 2008;53:874–6.CrossRefPubMed Artibani W, Novara G. Cancer-related outcome and learning curve in retropubic radical prostatectomy: if you need an operation, the most important step is to choose the right surgeon. Eur Urol. 2008;53:874–6.CrossRefPubMed
3.
go back to reference •• Abboudi H, Khan MS, Guru KA, Kamran A, et al. Learning curves for urological procedures: a systematic review. BJU Int. 2014;114:617–29. This article is a systematic review of learning curve studies within all urological procedures. It includes all the literature published 2011 backword. CrossRefPubMed •• Abboudi H, Khan MS, Guru KA, Kamran A, et al. Learning curves for urological procedures: a systematic review. BJU Int. 2014;114:617–29. This article is a systematic review of learning curve studies within all urological procedures. It includes all the literature published 2011 backword. CrossRefPubMed
4.
go back to reference Mirheydar HS, Parsons JK. Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health. World J Urol. 2013;31:455–61.CrossRefPubMed Mirheydar HS, Parsons JK. Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health. World J Urol. 2013;31:455–61.CrossRefPubMed
5.
go back to reference Khan N, Abboudi H, Kamran A, et al. Measuring the surgical learning curve: methods, variables and competency. BJU Int. 2014;113:504–8.CrossRefPubMed Khan N, Abboudi H, Kamran A, et al. Measuring the surgical learning curve: methods, variables and competency. BJU Int. 2014;113:504–8.CrossRefPubMed
6.
go back to reference Wiener S, Haddock P, Shichman S, Dorin R. Construction of a urologic robotic surgery training curriculum: how many simulator sessions are required for residents to achieve proficiency? J Endourol. 2015;29(11):1289–93.CrossRefPubMed Wiener S, Haddock P, Shichman S, Dorin R. Construction of a urologic robotic surgery training curriculum: how many simulator sessions are required for residents to achieve proficiency? J Endourol. 2015;29(11):1289–93.CrossRefPubMed
7.
go back to reference Kang SG, Ryu BJ, Yang KS, Ko YH, Cheon J, et al. An effective repetitive training schedule to achieve skill proficiency using a novel robotic virtual reality simulator. J Surg Educ. 2015;72(3):369–76.CrossRefPubMed Kang SG, Ryu BJ, Yang KS, Ko YH, Cheon J, et al. An effective repetitive training schedule to achieve skill proficiency using a novel robotic virtual reality simulator. J Surg Educ. 2015;72(3):369–76.CrossRefPubMed
8.
go back to reference Meier M, Horton K, John H. Da Vinci Skills Simulator™: is an early selection of talented console surgeons possible? J Robot Surg. 2016;10(4):289–296. Meier M, Horton K, John H. Da Vinci Skills Simulator™: is an early selection of talented console surgeons possible? J Robot Surg. 2016;10(4):289–296.
9.
go back to reference DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64:252–71.CrossRefPubMed DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64:252–71.CrossRefPubMed
10.
go back to reference Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: screening diagnosis and treatment of clinically localized disease. Eur Urol. 2011;59:61–71.CrossRefPubMed Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: screening diagnosis and treatment of clinically localized disease. Eur Urol. 2011;59:61–71.CrossRefPubMed
11.
go back to reference Ahlering TE. Robotic versus laparoscopic radical prostatectomy. Nat Clin Pract Urol. 2004;1:5–9.CrossRef Ahlering TE. Robotic versus laparoscopic radical prostatectomy. Nat Clin Pract Urol. 2004;1:5–9.CrossRef
12.
go back to reference Guillonneau B, el-Fettouh H, Baumert H, Catheineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1000 cases at Montsouris Institute. J Urol. 2003;169:1261–6.CrossRefPubMed Guillonneau B, el-Fettouh H, Baumert H, Catheineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1000 cases at Montsouris Institute. J Urol. 2003;169:1261–6.CrossRefPubMed
13.
go back to reference Gumus E, Boylu U, Turan T, Onol FF. The learning curve of robot-assisted radical prostatectomy. J Endourol. 2011;25:1633–7.CrossRefPubMed Gumus E, Boylu U, Turan T, Onol FF. The learning curve of robot-assisted radical prostatectomy. J Endourol. 2011;25:1633–7.CrossRefPubMed
14.
go back to reference O’Malley PJ, Van Appledorn S, Bouchier-Hayes DM, Crowe H, Costello AJ. Robotic radical prostatectomy in Australia: initial experience. World J Urol. 2006;24:165–70.CrossRefPubMed O’Malley PJ, Van Appledorn S, Bouchier-Hayes DM, Crowe H, Costello AJ. Robotic radical prostatectomy in Australia: initial experience. World J Urol. 2006;24:165–70.CrossRefPubMed
15.
go back to reference Gyomber D, Bolton D, Webb D, Harewood L, Crosthwaite A. An analysis of variability of learning curve, margin status and early post operative outcomes in 1200 robot assisted laparoscopic prostatectomies in a multi-user center. J Urol. 2010;183(4 Suppl. 1):e723.CrossRef Gyomber D, Bolton D, Webb D, Harewood L, Crosthwaite A. An analysis of variability of learning curve, margin status and early post operative outcomes in 1200 robot assisted laparoscopic prostatectomies in a multi-user center. J Urol. 2010;183(4 Suppl. 1):e723.CrossRef
16.
go back to reference Sooriakumaran P, John M, Leung R, et al. A multi-institutional study of 3794 patients undergoing robotic-assisted radical prostatectomy shows the learning curve is not as short as previously thought. Eur Urol Suppl. 2011;10:1569–9056. Sooriakumaran P, John M, Leung R, et al. A multi-institutional study of 3794 patients undergoing robotic-assisted radical prostatectomy shows the learning curve is not as short as previously thought. Eur Urol Suppl. 2011;10:1569–9056.
17.
go back to reference Vickers AJ, Savage CJ, Hruza M, Tuerk I, Koenig P, Luis M-P, et al. The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol. 2009;10(5):475–80.CrossRefPubMedPubMedCentral Vickers AJ, Savage CJ, Hruza M, Tuerk I, Koenig P, Luis M-P, et al. The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol. 2009;10(5):475–80.CrossRefPubMedPubMedCentral
18.
go back to reference Menon M, Tewai A, Baize B, et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002;60:864–8.CrossRefPubMed Menon M, Tewai A, Baize B, et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002;60:864–8.CrossRefPubMed
19.
go back to reference Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting-the learning curve and beyond: initial 200 cases. J Urol. 2005;174:369–272. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting-the learning curve and beyond: initial 200 cases. J Urol. 2005;174:369–272.
20.
go back to reference • Good DW, Steward GD, Laird A, Stolzenburg JU, Cahill D, SA MN. A critical analysis of the learning curve and post-learning curve outcomes of two experience- and volume-matched surgeons for laparoscopic and robot-assisted radical prostatectomy. J Endourol. 2015;29:1–9. This article investigates the learning curve for RALP and compared post-learning curve progresses between LRP and RALP. It shows superiority of RALP over LRP once LC achieved, which however does not seem to be significantly shorter. CrossRef • Good DW, Steward GD, Laird A, Stolzenburg JU, Cahill D, SA MN. A critical analysis of the learning curve and post-learning curve outcomes of two experience- and volume-matched surgeons for laparoscopic and robot-assisted radical prostatectomy. J Endourol. 2015;29:1–9. This article investigates the learning curve for RALP and compared post-learning curve progresses between LRP and RALP. It shows superiority of RALP over LRP once LC achieved, which however does not seem to be significantly shorter. CrossRef
21.
go back to reference Vasdev N, Bishop C, Kass-lliyya HS, McNicholas TA, Venkat P, Mohan-S G, et al. Developing a robotic prostatectomy service and a robotic fellowship programme-defining the learning curve. Curr Urol. 2013;7:136–44.CrossRefPubMed Vasdev N, Bishop C, Kass-lliyya HS, McNicholas TA, Venkat P, Mohan-S G, et al. Developing a robotic prostatectomy service and a robotic fellowship programme-defining the learning curve. Curr Urol. 2013;7:136–44.CrossRefPubMed
22.
go back to reference Lovegrove C, Novara G, Mottrie A, Ahmed K, et al. Structured and modular training pathway for robot-assisted radical prostatectomy (RARP): validation of the RARP assessment score and learning curve assessment. Eur Urol. 2016;69(3):526–35.CrossRefPubMed Lovegrove C, Novara G, Mottrie A, Ahmed K, et al. Structured and modular training pathway for robot-assisted radical prostatectomy (RARP): validation of the RARP assessment score and learning curve assessment. Eur Urol. 2016;69(3):526–35.CrossRefPubMed
23.
go back to reference Wang L, Diaz M, Stricker H, Peabody JO, Menon M, Rogers CG. Adding a newly trained surgeon into a high-volume robotic prostatectomy group: are outcomes compromised? J Robot Surg. 2017;11(1):69–74.CrossRefPubMed Wang L, Diaz M, Stricker H, Peabody JO, Menon M, Rogers CG. Adding a newly trained surgeon into a high-volume robotic prostatectomy group: are outcomes compromised? J Robot Surg. 2017;11(1):69–74.CrossRefPubMed
24.
go back to reference Di Pierro GB, Grande P, Wirth JG, Danuser H, Mattei A. Extended pelvic lymph node dissection at the time of robot-assisted radical prostatectomy: impact of surgical volume on efficacy and complications in a single-surgeon series. CUAJ. 2015;9(3–4):107–13.CrossRefPubMedPubMedCentral Di Pierro GB, Grande P, Wirth JG, Danuser H, Mattei A. Extended pelvic lymph node dissection at the time of robot-assisted radical prostatectomy: impact of surgical volume on efficacy and complications in a single-surgeon series. CUAJ. 2015;9(3–4):107–13.CrossRefPubMedPubMedCentral
25.
go back to reference Hayn MH, et al. The learning curve for robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2010;58:197–202.CrossRefPubMed Hayn MH, et al. The learning curve for robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2010;58:197–202.CrossRefPubMed
27.
go back to reference Richards KA, Kader K, Pettus JA, Smith JJ, Hemal AK. Does initial learning curve compromise outcomes for robot-assisted radical cystectomy? A critical evaluation of the first 60 cases while establishing a robotic program. J Endourol. 2011;25(9):1553–8.CrossRefPubMed Richards KA, Kader K, Pettus JA, Smith JJ, Hemal AK. Does initial learning curve compromise outcomes for robot-assisted radical cystectomy? A critical evaluation of the first 60 cases while establishing a robotic program. J Endourol. 2011;25(9):1553–8.CrossRefPubMed
28.
go back to reference Collins JW, Tyritzis S, Nyberg T, Schumacher MC, Laurin O, Adding C, et al. Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder—what is the effect of the learning curve on outcomes? BJU Int. 2014;113:100–7.CrossRefPubMed Collins JW, Tyritzis S, Nyberg T, Schumacher MC, Laurin O, Adding C, et al. Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder—what is the effect of the learning curve on outcomes? BJU Int. 2014;113:100–7.CrossRefPubMed
29.
go back to reference Y. Abu-Ghanem, Erlich T, Ramon J, Dotan Z, Zilberman DE. Robot assisted laparoscopic radical prostatectomy: assistant’s seniority has no influence of perioperative course. J Robot Surg. 2017;11(3):305–309. Y. Abu-Ghanem, Erlich T, Ramon J, Dotan Z, Zilberman DE. Robot assisted laparoscopic radical prostatectomy: assistant’s seniority has no influence of perioperative course. J Robot Surg. 2017;11(3):305–309.
30.
go back to reference Lavery HJ, Small AC, Samadi DB, Palese MA. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS. 2011;15:291–7.CrossRefPubMedPubMedCentral Lavery HJ, Small AC, Samadi DB, Palese MA. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS. 2011;15:291–7.CrossRefPubMedPubMedCentral
31.
go back to reference Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011;78:813–9.CrossRefPubMedPubMedCentral Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011;78:813–9.CrossRefPubMedPubMedCentral
32.
go back to reference Jacobsohn KM, Langenstroer P, Waples M, See W. Increasing experience leads to decreased warm ischemia times during robotic partial nephrectomy. J Endourol. 2011;25:A186. Jacobsohn KM, Langenstroer P, Waples M, See W. Increasing experience leads to decreased warm ischemia times during robotic partial nephrectomy. J Endourol. 2011;25:A186.
33.
go back to reference Mottrie A, De Naeyer G, Schatteman P, Carpentier P, Sangalli M, Ficarra V. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol. 2010;58:127–33.CrossRefPubMed Mottrie A, De Naeyer G, Schatteman P, Carpentier P, Sangalli M, Ficarra V. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol. 2010;58:127–33.CrossRefPubMed
34.
go back to reference • Paulucci DJ, Abaza R, Eun DD, Hemal AK, Badani KK. Robot-assisted partial nephrectomy: continued refinement of outcomes beyond the initial learning curve. BJU Int. 2016 8. Epub ahead print. Multi-center retrospective study to investigate post-LC outcomes for RAPN. Increasing the number of cases, surgeons are more prone to treat larger tumours minimizing complication, although 50 cases are sufficient to complete the procedure safely. • Paulucci DJ, Abaza R, Eun DD, Hemal AK, Badani KK. Robot-assisted partial nephrectomy: continued refinement of outcomes beyond the initial learning curve. BJU Int. 2016 8. Epub ahead print. Multi-center retrospective study to investigate post-LC outcomes for RAPN. Increasing the number of cases, surgeons are more prone to treat larger tumours minimizing complication, although 50 cases are sufficient to complete the procedure safely.
35.
go back to reference Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53.CrossRefPubMed Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53.CrossRefPubMed
36.
go back to reference Xie Y, Ma X, Liangyou G, Li H, Lv X, Yu G, et al. Associating the learning curve and tumor anatomical complexity with the margins, ischemia, and complications rate after robot-assisted partial nephrectomy. Int J Surg. 2016;36:219–24.CrossRefPubMed Xie Y, Ma X, Liangyou G, Li H, Lv X, Yu G, et al. Associating the learning curve and tumor anatomical complexity with the margins, ischemia, and complications rate after robot-assisted partial nephrectomy. Int J Surg. 2016;36:219–24.CrossRefPubMed
37.
go back to reference Buffi N, Lista G, Larcher A, et al. Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol. 2012;62:617–8.CrossRefPubMed Buffi N, Lista G, Larcher A, et al. Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol. 2012;62:617–8.CrossRefPubMed
Metadata
Title
Learning Curves for Robotic Surgery: a Review of the Recent Literature
Authors
Giorgio Mazzon
Ashwin Sridhar
Gerald Busuttil
James Thompson
Senthil Nathan
Tim Briggs
John Kelly
Greg Shaw
Publication date
01-11-2017
Publisher
Springer US
Published in
Current Urology Reports / Issue 11/2017
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-017-0738-z

Other articles of this Issue 11/2017

Current Urology Reports 11/2017 Go to the issue

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Lifetime Radiation Exposure in Patients with Recurrent Nephrolithiasis

Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)

Incidence and Management of De Novo Lower Urinary Tract Symptoms After Pelvic Organ Prolapse Repair

New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)

Characterizing Indeterminate Renal Masses with Molecular Imaging: the Role of 99mTc-MIBI SPECT/CT