title: [New approach of learning curve for robotic-assisted gynecologic oncology surgery].
abstract: OBJECTIVE
  Define the phases composing the learning curve of total hysterectomy (TH) and radical hysterectomy with pelvic lymphadenectomy (RHPL) robot-assisted performed by a single surgeon with no prior experience in laparoscopic surgery.
  
  
  METHODS
  We retrospectively analyzed 72 procedures (TH, n=34 and RHPL, n=38) conducted between 2002 and 2011. The surgeon console time (CT) was used to determine the learning curve of TH and RHPL using CUSUM analysis. Epidemiological data, perioperative and postoperative complications were compared from the different phases of the learning curve.
  
  
  RESULTS
  CUSUM analysis of surgeon console time (CUSUMCT) identified two learning phases for the TH group (phase 1: initial learning, phase 2: surgical skill increase). For the RHPL group, three learning phases were identified (phase 1: initial learning, phase 2: extending surgical indications, phase 3: control of surgical skills). Perioperative and postoperative complication rates did not differ significantly between the learning phases. Surgeon CT decreased from the 9th case (P=0.01) for the TH group and from the 13th case (P=0.04) for the RHPL group.
  
  
  CONCLUSIONS
  CUSUM analysis of the learning curve in robotic-assisted gynecologic oncology surgery identified two phases of learning curve for simple procedures such as total hysterectomy and three phases for more complex procedures as radical hysterectomy with pelvic lymphadenectomy.
authors: Département de chirurgie, institut de cancérologie de Lorraine-Alexis-Vautrin, université de Lorraine, 6, avenue de bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France. Electronic address: shaghayari@gmail.com.
authors: S
authors: S
authors: Yaribakht
authors: Département de chirurgie, institut de cancérologie de Lorraine-Alexis-Vautrin, université de Lorraine, 6, avenue de bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France.
authors: F
authors: F
authors: Guillemin
authors: Département d'information hospitalière, institut de cancérologie de Lorraine-Alexis-Vautrin, université de Lorraine, 6, avenue de bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France.
authors: V
authors: V
authors: Harter
authors: Service de gynécologie-obstétrique, maternité régionale universitaire de Nancy, université Nancy-I-Henri-Poincaré, 10, rue du Dr.-Heydenreich, 54000 Nancy, France.
authors: C
authors: C
authors: Malartic
authors: UMR 7039, département de chirurgie CRAN, CNRS institut de cancérologie de Lorraine, université de Lorraine, 6, avenue de bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France.
authors: F
authors: F
authors: Marchal
mesh_terms: D005260:Female; D005602:France; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures
keywords: CUSUM analysis; Cancer de l’endomètre; Cancer du col utérin; Cervical cancer; Chirurgie robot-assistée; Courbe d’apprentissage; Endometrial cancer; Learning curve; Méthode CUSUM; Robotic assisted-surgery