title: Learning curve analysis of mitral valve repair using telemanipulative technology.
abstract: OBJECTIVE
  To determine if the time required to perform mitral valve repairs using telemanipulation technology decreases with experience and how that decrease is influenced by patient and procedure variables.
  
  
  METHODS
  A single-center retrospective review was conducted using perioperative and outcomes data collected contemporaneously on 458 mitral valve repair surgeries using telemanipulative technology. A regression model was constructed to assess learning with this technology and predict total robot time using multiple predictive variables. Statistical analysis was used to determine if models were significantly useful, to rule out correlation between predictor variables, and to identify terms that did not contribute to the prediction of total robot time.
  
  
  RESULTS
  We found a statistically significant learning curve (P < .01). The institutional learning percentage∗ derived from total robot times† for the first 458 recorded cases of mitral valve repair using telemanipulative technology is 95% (R(2) = .40). More than one third of the variability in total robot time can be explained through our model using the following variables: type of repair (chordal procedures, ablations, and leaflet resections), band size, use of clips alone in band implantation, and the presence of a fellow at bedside (P < .01).
  
  
  CONCLUSIONS
  Learning in mitral valve repair surgery using telemanipulative technology occurs at the East Carolina Heart Institute according to a logarithmic curve, with a learning percentage of 95%. From our regression output, we can make an approximate prediction of total robot time using an additive model. These metrics can be used by programs for benchmarking to manage the implementation of this new technology, as well as for capacity planning, scheduling, and capital budget analysis.
authors.affiliation: East Carolina Heart Institute, Greenville, NC, USA. pjc1020@yahoo.com
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Charland
authors.forename: Tom
authors.initials: T
authors.lastname: Robbins
authors.forename: Evilio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Wiley L
authors.initials: WL
authors.lastname: Nifong
authors.forename: Randolph W
authors.initials: RW
authors.lastname: Chitwood
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000193:education; D006801:Humans; D059032:Learning Curve; D008943:Mitral Valve / Q000601:surgery*; D008962:Models, Theoretical; D012189:Retrospective Studies; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013997:Time Factors