title: Learning Curve of Robotic-Assisted Anastomosis: Shorter than the Laparoscopic Technique? An Educational Study.
abstract: BACKGROUND
  Achieving aortic anastomosis in laparoscopic surgery remains a technical challenge. The Da Vinci robot could theoretically counteract this issue by minimizing the technical challenge. The aim of this study was to compare the learning curves of performing vascular anastomoses by trainees without any experience using purely laparoscopic versus robotic-assisted techniques.
  
  
  METHODS
  Surgery residents were randomly included in the laparoscopic group (group A, n = 3) and the robotic group (group B, n = 3). They performed 10 end-to-end anastomoses on 18-mm-diameter tubular expanded polytetrafluoroethylene grafts. The parameters recorded were duration to complete the anastomosis and an indirect sealing quality evaluation (ISQE) defined as the following ratio: number of stitches with a distance of less than 4 mm/total number of stitches.
  
  
  RESULTS
  The mean duration to perform the anastomosis decreased from 2340 s (±64) for the first anastomosis to 651 s (±248) for the last in group A (P < 0.05) and from 1989 s (±556) to 801 s (±120) in group B (P < 0.05). The mean ISQE increased from 74% (±18) for the first anastomosis to 98% (±3) for the last in group A (P < 0.05) and decreased from 100% to 98% (±2) in group B (nonsignificant). The mean duration to perform the first anastomosis was lower in group B than in group A (P < 0.05). The mean duration to perform the last anastomosis was not significantly different between the groups. Sealing tended to be better in group B for the first anastomosis compared with group A.
  
  
  CONCLUSIONS
  Minimally invasive laparoscopic technique training demonstrates a learning curve to perform vascular anastomoses. The robotic-assisted technique tended to improve suturing skills and should be considered as a valuable tool to reduce the technical learning curve.
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lucereau
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France. Electronic address: Fabien.thaveau@chru-strasbourg.fr.
authors.forename: Fabien
authors.initials: F
authors.lastname: Thaveau
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lejay
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roussin
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Georg
authors.affiliation: Laboratoire de Physique et Mécanique des Textiles, Université de Haute-Alsace, Mulhouse, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Heim
authors.affiliation: Department of Vascular Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Nabil
authors.initials: N
authors.lastname: Chakfe
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000193:education* / Q000295:instrumentation; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D009048:Motor Skills; D061646:Operative Time; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D065287:Robotic Surgical Procedures / Q000193:education*; D013536:Suture Techniques; D013997:Time Factors
chemical_list: D011138:Polytetrafluoroethylene