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Learning Curve & Safety Analysis After 170 Robotic-assisted Cases In Thoracic Surgery: Experience From A High Volume Canadian Centre
Rena P. Seeger
1, Urmila Bhattacharyya, MPH
1, Angie Stackhouse, RN
2, Sebastien Gilbert, MD
1, Daniel G. Jones, MD MPH
1,
Patrick J. Villeneuve, MD PhD1.
1The University of Ottawa, Ottawa, ON, Canada,
2TheOttawa Hospital, Ottawa, ON, Canada.
BACKGROUND: Robotic technology in thoracic oncology continues to gain popularity, with accruing evidence demonstrating improved intraoperative dissection techniques, reduction in length of stay and reduced postoperative adverse events. At the Ottawa Hospital, robotic-assisted (RATS) procedures have been conducted since 2022. We sought to evaluate the trends in surgeon performance for RATS by evaluating: 1) Operative times and surgical efficiency using learning curves, and 2) Patient safety using conversion rates (RATS to video-assisted thoracic surgery (VATS)) and post-operative AEs.
METHODS: Data was obtained from two prospectively maintained databases, encompassing 170 robotic-assisted procedures from April 2022 to November 2024 and adverse event data (www.ottawatmm.org). Learning curve, assessed by trends in operative console time, and patient safety was evaluated. Descriptive statistics were performed using Microsoft Excel (Redmond, WA USA), cumulative sum (CUSUM) analysis was conducted using R software (RStudio Team, Version 8). Ethics approval was obtained.
RESULTS: Our full cohort includes 170 robotic-assisted thoracic surgery cases. 70 were male, the average age was 65.06. 144 cases had complete time data, the breakdown of which is as follows: 105 pulmonary cases (83 lobectomies, 11 wedge resections, 10 segmentectomies), and 39 mediastinal cases (30 anterior resections, 9 posterior resections). Mean console time for all complete cases was 126 minutes, with a mean docking time of 24 minutes. For both lobectomies and anterior mediastinal resections, we observe increased time efficiency, seeing a steady decrease in operative time after 41 cases and 15 cases, respectively. Average length of stay was 3.11 days. There were 58 total complications across 40 patients. Majority of complications (n=43, 73%) were a Grade II comprised of prolonged air leak (n=19, 32%). Out of our 170 cases, 17 (10%) were converted non-urgently to VATS, primarily due to complex anatomy. Only three cases were non-urgently converted to VATS due to bleeding.
CONCLUSIONS: We demonstrate the safety and surgical efficiency of the introduction of RATS. Specifically, the safety profile of RATS is excellent, with no mortalities or emergency conversions. Our collective learning curves for pulmonary and anterior mediastinal resections are comparable to our institutionally established VATS experience, and consistent with established evidence.
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