title: How does the surgeon's experience of abdominal operations influence the learning curves for robot-assisted vascular anastomosis?
abstract: OBJECTIVE
  Endoscopic vascular anastomosis of abdominal aortic aneurysms is rarely performed and requires standardization. Here, we examined the impact of the surgeon's experience of abdominal aortic aneurysm surgery on the learning curve for robot-assisted endoscopic vascular anastomosis.
  
  
  METHODS
  Three vascular surgeons with more than 10 years' experience (group A), three vascular surgeons with less than 10 years' experience (group B), and three medical students with no experience (group C) of performing vascular surgery used the da Vinci surgical system to anastomose 8-mm-diameter vascular prostheses in an end-to-end manner with continuous 5-0 Prolene sutures. The procedure was performed five times by each participant. Outcomes were anastomosis time, number of actions, visual score, and pressure test. Snapping of the prolene thread was recorded as a procedural failure.
  
  
  RESULTS
  Procedural failure occurred only in group C (3/15 trials, 20%; P < 0.0001). Learning curves were apparent in all three groups for anastomosis time and in groups A and C for the number of actions. Between trials 1 and 5, learning curves were apparent in all three groups for anastomosis time and in groups A and C for the number of actions but were not apparent for leakage or visual score in any group. Visual score and leakage were not significantly different among the three groups in each trial (P = 0.10 and P = 0.45, respectively).
  
  
  CONCLUSIONS
  By using the da Vinci surgical system, experienced vascular surgeons and surgically naive students showed marked improvements in vascular anastomosis techniques with a short period of training.
authors.affiliation: From the Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Soga
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ishikawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kimura
authors.forename: Makoto
authors.initials: M
authors.lastname: Oda
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D012371:Robotics / Q000193:education*; D014656:Vascular Surgical Procedures / Q000193:education* / Q000379:methods