title: Learning curve for robot-assisted Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Robot-assisted Roux-en-Y gastric bypass (RYGBP) is rapidly evolving as an important surgical approach in the bariatric field. However, the specific learning curve associated with this new approach remains poorly investigated. This study aimed to evaluate the learning curve for robot-assisted RYGBP.
  
  
  METHODS
  A series of 64 consecutive robot-assisted RYGBP procedures were performed between December 2008 and December 2010 by a single surgeon already experienced in advanced laparoscopic procedures but not in bariatric surgery. All data were collected prospectively in a database and reviewed retrospectively. The learning curve was evaluated using the cumulative sum (CUSUM) method.
  
  
  RESULTS
  Women comprised 76.6% and men 23.4% of this series. These patients had a mean age of 43 years and a mean body mass index (BMI) of 44.5 kg/m(2). The mean operative time (OT) was 238.1 min (range, 150-400 min). A total of six complications occurred (9.4%). The CUSUM learning curve consisted of two distinct phases: phase 1 (the initial 14 cases; mean OT, 288.9 min) and phase 2 (the subsequent cases; mean OT, 223.6 min), which represented the mastery phase, with a decrease in OT (P = 0.0001). The two groups were similar in terms of gender, age, and BMI. The two phases did not differ in terms of complications or hospital stay.
  
  
  CONCLUSIONS
  This series confirms previous study findings concerning the feasibility and the safety of robotic RYGBP even after a limited experience with laparoscopic RYGBP. The data reported in this article suggest that the learning phase for robot-assisted RYGBP can be achieved with 14 cases.
authors: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil, 4, 1211, Geneva 14, Switzerland. Nicolas.c.buchs@hcuge.ch
authors: Nicolas C
authors: NC
authors: Buchs
authors: François
authors: F
authors: Pugin
authors: Pascal
authors: P
authors: Bucher
authors: Monika E
authors: ME
authors: Hagen
authors: Gilles
authors: G
authors: Chassot
authors: Pascale
authors: P
authors: Koutny-Fong
authors: Philippe
authors: P
authors: Morel
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012371:Robotics / Q000193:education* / Q000592:standards