title: Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves.
abstract: BACKGROUND
  Laparoscopy offers some evidence of benefit compared to open rectal surgery. Robotic rectal surgery is evolving into an accepted approach. The objective was to analyze and compare laparoscopic and robotic rectal surgery learning curves with respect to operative times and perioperative outcomes for a novice minimally invasive colorectal surgeon.
  
  
  METHODS
  One hundred and six laparoscopic and 92 robotic LAR rectal surgery cases were analyzed. All surgeries were performed by a surgeon who was primarily trained in open rectal surgery. Patient characteristics and perioperative outcomes were analyzed. Operative time and CUSUM plots were used for evaluating the learning curve for laparoscopic versus robotic LAR.
  
  
  RESULTS
  Laparoscopic versus robotic LAR outcomes feature initial group operative times of 308 (291-325) min versus 397 (373-420) min and last group times of 220 (212-229) min versus 204 (196-211) min-reversed in favor of robotics; major complications of 4.7 versus 6.5 % (NS), resection margin involvement of 2.8 versus 4.4 % (NS), conversion rate of 3.8 versus 1.1 (NS), lymph node harvest of 16.3 versus 17.2 (NS), and estimated blood loss of 231 versus 201 cc (NS). Due to faster learning curves for extracorporeal phase and total mesorectal excision phase, the robotic surgery was observed to be faster than laparoscopic surgery after the initial 41 cases. CUSUM plots demonstrate acceptable perioperative surgical outcomes from the beginning of the study.
  
  
  CONCLUSIONS
  Initial robotic operative times improved with practice rapidly and eventually became faster than those for laparoscopy. Developing both laparoscopic and robotic skills simultaneously can provide acceptable perioperative outcomes in rectal surgery. It might be suggested that in the current milieu of clashing interests between evolving technology and economic constrains, there might be advantages in embracing both approaches.
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada, jiri.melich@mail.mcgill.ca.
authors.forename: George
authors.initials: G
authors.lastname: Melich
authors.forename: Young Ki
authors.initials: YK
authors.lastname: Hong
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: A
authors.initials: A
authors.lastname: Sender Liberman
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
mesh_terms: D000368:Aged; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012004:Rectal Neoplasms / Q000601:surgery*; D012371:Robotics / Q000193:education* / Q000379:methods; D066231:Surgeons / Q000193:education*; D016896:Treatment Outcome