• Min Seo Kim, Won Jun Kim, Woo Jin Hyung, Hyoung-Il Kim, Sang-Uk Han, Young-Woo Kim, Keun Won Ryu, and Sungsoo Park.
• Korea University College of Medicine, Seoul, Republic of Korea.
• Ann. Surg. 2021 May 1; 273 (5): 949-956.

ObjectiveTo evaluate the complication-based learning curve and identify learning-associated complications of robotic gastrectomy.Summary Background DataWith the increased popularity of robotic surgery, a sound understanding of the learning curve in the surgical outcome of robotic surgery has taken on great importance. However, a multicenter prospective study analyzing learning-associated morbidity has never been conducted in robotic gastrectomy.MethodsData on 502 robotic gastrectomy cases were prospectively collected from 5 surgeons. Risk-adjusted cumulative sum analysis was applied to visualize the learning curve of robotic gastrectomy on operation time and complications.ResultsTwenty-five cases, on average, were needed to overcome complications and operation time-learning curve sufficiently to gain proficiency in 3 surgeons. An additional 23 cases were needed to cross the transitional phase to progress from proficiency to mastery. The moderate complication rate (CD ≥ grade II) was 20% in phase 1 (cases 1-25), 10% in phase 2 (cases 26-65), 26.1% in phase 3 (cases 66-88), and 6.4% in phase 4 (cases 89-125) (P < 0.001). Among diverse complications, CD ≥ grade II intra-abdominal bleeding (P < 0.001) and abdominal pain (P = 0.01) were identified as major learning-associated morbidities of robotic gastrectomy. Previous experience on laparoscopic surgery and mode of training influenced progression in the learning curve.ConclusionsThis is the first study suggesting that technical immaturity substantially affects the surgical outcomes of robotic gastrectomy and that robotic gastrectomy is a complex procedure with a significant learning curve that has implications for physician training and credentialing.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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