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Multifactorial Analysis of the Learning Curve for Totally Robotic Roux-en-Y Gastric Bypass for Morbid Obesity

Abstract : Background Laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric operation worldwide for the surgical management of obesity. Totally robotic Roux-en-Y gastric bypass (TR-RYGBP) has been considered to be a better approach by some groups especially early in a surgeon's experience. However, the learning curve associated with TR-RYGBP has been poorly evaluated yet. The aim of this study was to evaluate the learning curve of patients who underwent TR-RYGBP. Methods This is a prospective study of 154 first consecutive patients undergoing TR-RYGBP to analyze the influence of surgeon experience, bedside first assistant, and patient factors on operative time and postoperative complications. To give a comprehensive view of success related to the learning process, a single hybrid variable was generated. Multivariate analysis predicted the risk factors for complications and operative time. A risk-adjusted cumulative sum analysis estimated the learning curve. Results The learning curve for TR-RYGBP was 84 cases. Case rank and first assistant level were independent predictors of total operative time. Overall 30-day postoperative morbidity rate was 33.1 % and decreased over time. Surgeon experience (OR 2.6; CI 95 [1.290 to 5.479]; p = 0.0081) and first assistant level (OR 2.42; CI 95 [1.197 to 4.895]; p = 0.0139) remained independent predictors of composite event (operative time and complications). Conclusions This study identifed criteria that should be assessed in future studies about TR-RYGBP. Both surgeon experience and bedside first assistant level affected operative duration, but surgeon experience was the most significant factor in reducing complication rates.
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https://hal.univ-lorraine.fr/hal-01706649
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Submitted on : Monday, February 12, 2018 - 10:34:16 AM
Last modification on : Sunday, October 25, 2020 - 7:05:35 AM

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Myriam Renaud, Nicolas Reibel, Rasa Zarnegar, Adeline Germain, Didier Quilliot, et al.. Multifactorial Analysis of the Learning Curve for Totally Robotic Roux-en-Y Gastric Bypass for Morbid Obesity. Obesity Surgery, Springer Verlag, 2013, 23 (11), pp.1753 - 1760. ⟨10.1007/s11695-013-1020-1⟩. ⟨hal-01706649⟩

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