Learning Curve of Robotic Lobectomy for the Treatment of Lung Cancer: How Does It Impact on the Autonomic Nervous System of the Surgeon?

Objective: Our purpose is to define the learning curve for robot-assisted thoracoscopic surgery lobectomy by reporting the experience of a single surgeon. Material and methods: We progressively collected the data concerning the surgical performance of a single male thoracic surgeon, from the beginning of his robotic activity as first operator from January 2021 to June 2022. We evaluated several pre-, intra- and postoperative parameters concerning patients and intraoperative cardiovascular and respiratory outcomes of the surgeon, recorded during surgical interventions, in order to evaluate his cardiovascular stress. We used cumulative sum control charts (CUSUM) to analyze the learning curve. Results: A total of 72 lung lobectomies were performed by a single surgeon in this period. Analyzing the CUSUM of several parameters, the inflection point identifying the transition beyond the surgeon learning phase was reached at cases 28, 22, 27 and 33 when considering operating time, mean heart rate, max heart rate and mean respiratory rate, respectively. Conclusions: The learning curve for robotic lobectomy seems to be safe and feasible with a correct robotic training program. The analysis of a single surgeon from the beginning of his robotic activity demonstrates that confidence, competence, dexterity and security are achieved after about 20-30 procedures, without compromising efficiency and oncological radicality.

Automated summary

The aim of this study was to define the learning curve for robot-assisted thoracoscopic surgery lobectomy by analyzing the experience of a single surgeon. Data on surgical performance and cardiovascular and respiratory outcomes were collected from January 2021 to June 2022. Cumulative sum control charts were used to analyze the learning curve. The results showed that the transition beyond the learning phase occurred at different case numbers for various parameters. The study concluded that robotic lobectomy has a safe and feasible learning curve with adequate training, and confidence and competence can be achieved after approximately 20-30 procedures without compromising surgical efficiency and oncological radicality.