title: Robotic Versus Laparoscopic Right Colectomy for Colon Cancer: Analysis of the Initial Simultaneous Learning Curve of a Surgical Fellow.
abstract: BACKGROUND
  Robotic surgery was introduced to overcome laparoscopic drawbacks. This study aimed to compare the learning curve of robotic-assisted right colectomy (RRC) versus laparoscopic-assisted right colectomy (LRC) for colon cancer with respect to operative times and perioperative outcomes. In addition, the health-related costs associated with both procedures were analyzed and compared.
  
  
  METHODS
  Between 2012 and 2015, 30 consecutive patients underwent RRC and 50 patients LRC for colon cancer. All procedures were performed by a surgical fellow novice in minimally invasive colorectal surgery. The operative time and the cumulative sum method were used to evaluate the learning curve of RRC versus LRC.
  
  
  RESULTS
  The mean operative times were 200.5 minutes for RRC and 204.1 minutes for LRC (P = .408) and showed a significant decrease over consecutive procedures (P < .0001). The number of cases necessary to identify a drop in the operative time was 16 for RRC and 25 for LRC. RRC procedures were associated with significantly reduced blood loss (P = .012). Two patients (4%) in the LRC group were converted to laparotomy, whereas no conversion was required in the RRC group. Surgery-related costs were significantly more expensive for RRC, but when combined with the hospitalization-related costs, LRC and RRC did not differ (P = .632).
  
  
  CONCLUSIONS
  Both robotic and laparoscopic operative times decrease rapidly with practice. However, RRC is associated with a faster learning curve than LRC. The simultaneous development of these two minimally invasive approaches appears to be safe and feasible with acceptable health-related costs.
authors.affiliation: Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France .
authors.forename: Nicola
authors.initials: N
authors.lastname: de'Angelis
authors.affiliation: Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France .
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lizzi
authors.affiliation: Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France .
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France .
authors.forename: Francesco
authors.initials: F
authors.lastname: Brunetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002430:Cecal Neoplasms / Q000601:surgery*; D003082:Colectomy / Q000193:education* / Q000379:methods; D044682:Colon, Ascending / Q000601:surgery*; D044684:Colon, Transverse / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education*; D061887:Conversion to Open Surgery; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000193:education* / Q000379:methods
keywords: colon cancer; laparoscopy; learning curve; right colectomy; robotic surgery