The learning curve of robotic cardiac surgery: a scoping review

Abstract

This systematic review aims to investigate the learning curve associated with robotic cardiac surgical procedures and its impact on operative efficiency and patient outcomes. An electronic search of MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Library databases was conducted in October 2023. Studies reporting outcomes of robotic cardiac surgical procedures during the early phase of the learning curve process were included. Intraoperative metrics and clinical outcomes were examined. Following the removal of duplicates, 2305 citations were screened, with 32 studies meeting inclusion criteria for full-text screening. Seven studies focused on totally endoscopic coronary artery bypass (TECAB), 12 on robotic mitral valve repair (MVR), and 8 on robotic coronary artery bypass grafting (CABG). Analysis revealed improved procedural efficiency along the learning curve, evidenced by reductions in surgical durations and operative complications. Notable enhancements were observed in total procedure time, bypass time, harvest time, and cross-clamp/occlusion time. Low mortality rates were consistently reported at both 30 days and 1-year post-surgery. As surgeons progress along the learning curve, there is a notable improvement in procedural efficiency and a reduction in adverse events. However, variability in the number of procedures required to attain proficiency suggests the influence of program size and individual surgeon experience. Standardized training protocols and ongoing mentorship are essential to optimize the learning curve while ensuring patient safety. Further research employing standardized metrics to define competency thresholds and expedite the learning process is warranted to enhance the proficiency of robotic cardiac surgeons.