Back to Annual Meeting Program

Introduction: The expansion of robotic-assisted surgery is occurring quickly, though little is generally known about the “learning curve” for the technology with utilization for complex esophageal procedures. The purpose of this study is to define the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety.
Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts of 10 patients. Our measures of proficiency included: operative times, conversion rates, and complications.
Results: Fifty-two patients (41 (78.8%) male: 11 (22.2%) female) of mean age 66.2 ± 8.8 years underwent robotic-assisted esophagogastrectomies for malignant esophageal disease. Neoadjuvant chemoradiation was administered to 35 (67.3%) patients. A significant reduction in operative times (p<0.005) following completion of 20 procedures was identified (514 ± 106 vs. 397 ± 71.9). No significant reduction in the number of procedures requiring conversions to open operations was observed. Complication rates were low, and not significantly different between any 10-patient cohort, although no complications occurred in the final 10-patient cohort (Figure 1). However the frequency of complications decreased significantly after 28 cases: 9 (32.1%) vs 3 (12.5%) p=0.04. There were no in hospital mortalities.
Conclusions: For surgeons proficient in performing minimally invasive esophagogastrectomies, the learning curve for a robotic-assisted procedure appears to begin near proficiency after 20 cases. However this may be increased in surgeons transitioning from an open approach. Operative complications and conversions were infrequent and unchanged across successive 10-patient cohorts and appear to be less then smaller previously published series. In addition, there is a decrease in frequency of complications after 28 cases.