The learning curve of robotic lobectomy

Background: Robotic lobectomy has been shown to be feasible, safe and oncologically efficacious. The actual learning curve of robotic lobectomy has yet to be defined. This study was designed to define the learning curve of robotic lobectomy. Methods: We performed a retrospective review of prospectively accrued patients at our institution who underwent robotic lobectomy from January 2004 until December 2011. Six scatter graphs were constructed, comparing operative time, conversion rate, morbidity, mortality, length of stay and surgeon comfort with the number of consecutive cases. In each graph, a regression trendline was drawn and the change in the slope of the curve corresponding to the beginning of the plateau defined the learning curve. The overall learning curve was defined as mean±SD of the sum of the individual learning curves. Results: Based on operative times, mortality and surgeon comfort, the overall learning curve was 18±3 cases. The learning curve based on operative times, mortality and surgeon comfort was 15, 20 and 19 cases, respectively. There was no association between the need for conversion and number of consecutive cases. There was a trend towards lower morbidity and decreased length of stay with greater experience. However, these parameters did not define a specific learning curve. Conclusions: Operative time, mortality and surgeon comfort were found to be key parameters for the learning curve of robotic lobectomy when performed by surgeons who are experienced with video-assisted thoracic surgery (VATS). The learning curve was 18±3 cases.