title: Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The robotic platform might offer superior ergonomics over other minimally invasive approaches. However, the increased time required for instrument set-up, operations, and surgical training are perceived as major drawbacks. There is limited literature on this topic, therefore we report our experience at an academic tertiary medical center in the USA. The primary aim of this study was to analyze the learning curve and the times for necessary steps for singly docked totally robotic Roux-en-Y gastric bypass (RREYGB).
  
  
  METHODS
  From November 2010 to April 2013, all consecutive patients who underwent RREYGB were retrospectively analyzed from a prospectively maintained database. Variables of interest for this study were patient demographics, preoperative body mass index, previous surgical history, clinically relevant perioperative events, and operative times for various steps in the procedure.
  
  
  RESULTS
  During the study period, a total of 32 patients were enrolled. The mean age was 39.9 ± 9.7 years (range 25-60), preoperative weight was 120.9 ± 21.5 kg (range 76.7-184.6), and body mass index (BMI) was 44.7 ± 5.3 kg/m(2) (range 36.1-61). The mean total operative time was 187.3 ± 36.4 min (range 130-261). The time necessary for trocar placement was 11.9 ± 4.5 min (range 4-23), robot set-up was 8.5 ± 3.6 min (range 3-20), pouch creation was 32 ± 10.11 min (range 16-56), gastrojejunal anastomosis was 59.5 ± 12.3 min (range 39-90), jejunojejunal anastomosis was 33.5 ± 9.6 min (range 18-65), and endoscopy/hemostasis was 12.9 ± 7.2 min (range 2-34). Operative time significantly improved after eight cases.
  
  
  CONCLUSIONS
  In a high-volume established robotic bariatric center, robot set-up, operative times, and learning curve are shorter than previously reported.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood St., Mail Code 958, Suite 435E, Chicago, IL, 60612, USA, drsayloo@gmail.com.
authors.forename: Subhashini
authors.initials: S
authors.lastname: Ayloo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fernandes
authors.forename: Nabajit
authors.initials: N
authors.lastname: Choudhury
mesh_terms: D000328:Adult; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000193:education* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012371:Robotics / Q000193:education* / Q000295:instrumentation*; D013997:Time Factors