Learning curve for robot-assisted neck dissection in head and neck cancer: a 3-year prospective case study and analysis.
OBJECTIVE
Robot-assisted neck dissection (RAND) for the management of regional metastases is a recently developed technique in the field of head and neck cancer that uses a robotic surgical system. This is the first report that estimates the learning curve for RAND.


OBJECTIVE
To evaluate a learning curve for RAND according to the types of neck dissection and report clinical outcomes.


METHODS
Prospective case study of 90 patients undergoing neck dissection between May 2010 and April 2013 at a university tertiary referral center.


METHODS
Fifty modified radical neck dissections (MRNDs) and 40 supraomohyoid neck dissections (SONDs) were performed by a single surgeon using a robotic surgical system to treat head and neck cancer. The MRND and the SOND groups were subdivided into 5 and 4 consecutive subgroups of 10 patients each, respectively.


METHODS
Perioperative parameters were compared, including mean operation time, duration and amount of drainage, length of hospital stay, and postoperative complications.


RESULTS
Significant decreases in mean operation time were observed as experience performing RAND increased in both the MRND and the SOND groups. The mean operation time for the MRND group decreased by 29% over the course of our study (initial subgroup, 298.1 minutes; last subgroup, 212.4 minutes). The mean operation time for the SOND group decreased by 53% over the course of our study (initial subgroup, 226.5 minutes; last subgroup, 106.1 minutes). There were no significant differences between subgroups for the other perioperative parameters.


CONCLUSIONS
We explored the RAND learning curve in a single institution over a 3-year period. This study can be used as a timeline reference for institutions where the RAND procedure will be adopted as an alternative procedure.
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Won Shik
WS
Kim
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Myung Jin
MJ
Ban
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Jae Won
JW
Chang
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Hyung Kwon
HK
Byeon
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Hwan
H
Kim
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Ji Hyuk
JH
Han
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Yoon Woo
YW
Koh
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
Eun Chang
EC
Choi
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004322:Drainage; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000193:education*; D061646:Operative Time; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education*; D016896:Treatment Outcome