Evaluating the learning curve in robot-assisted laparoscopic total hysterectomy: single-port versus multi-port Da Vinci platforms

Abstract

The aim of this study is to assess and compare the learning curves of the Da Vinci S Multi-port (MP) and Da Vinci Single-Port (SP) platforms for total hysterectomy, with particular attention to how prior MP experience influences SP performance. This is a retrospective comparative study on patients undergoing robot-assisted total hysterectomy (benign or early endometrial cancer indication) with the MP and SP systems. All operations were performed by the same surgeon, and cases performed with the SP system were performed after the MP system. Operating time was used as the main indicator of the learning curve, analyzed by the CUSUM method. Data were processed with R software, and differences between groups were evaluated with t-test and Chi-squared test (significance p < 0.05). A total of 147 patients were analyzed (73 MP, 74 SP). Mean operating times were similar between the two groups (117 min MP vs. 114 min SP). Hemoglobin drop was significantly lower in the SP group (- 1.18 g/dL vs. - 2.07 g/dL, p < 0.05). CUSUM analysis showed that the learning curve of the MP system reaches the mastery phase after 50 cases, while 13 cases are sufficient for the SP system when initiated after having mastered the MP system. The learning rate was - 0.3 min/case for MP and - 0.009 min/case for SP. In conclusion much of the experience gained with the Da Vinci Multiport System is transferable to the SP platform, allowing for a shorter learning curve and rapid achievement of surgical mastery with similar learning phases.