Learning Curves in Robotic Rectal Cancer Surgery: A literature Review

Abstract

Background: Laparoscopic rectal cancer surgery offers several advantages over open surgery, including quicker recovery, shorter hospital stay and improved cosmesis. However, laparoscopic rectal surgery is technically difficult and is associated with a long learning curve. The last decade has seen the emergence of robotic rectal cancer surgery. In contrast to laparoscopy, robotic surgery offers stable 3D views with advanced dexterity and ergonomics in narrow spaces such as the pelvis. Whether this translates into a shorter learning curve is still debated. The aim of this literature search is to ascertain the learning curve of robotic rectal cancer surgery. Methods: This review analyses the literature investigating the learning curve of robotic rectal cancer surgery. Using the Medline database a literature search of articles investigating the learning curve of robotic rectal surgery was performed. All relevant articles were included. Results: Twelve original studies fulfilled the inclusion criteria. The current literature suggests that the learning curve of robotic rectal surgery varies between 15 and 44 cases and is probably shorter to that of laparoscopic rectal surgery. Conclusions: There are only a few studies assessing the learning curve of robotic rectal surgery and they possess several differences in methodology and outcome reporting. Nevertheless, current evidence suggests that robotic rectal surgery might be easier to learn than laparoscopy. Further well designed studies applying CUSSUM analysis are required to validate this motion.