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<p>The robotic NICE procedure is a novel minimally invasive approach in colorectal surgery, yet its learning curve remains undefined; this study aimed to define its distinct phases by analyzing operative time trends. A retrospective review of 170 consecutive NICE procedures performed by a single surgeon between May 2018 and August 2019 was undertaken. Skin-to-skin operative time was the learning curve surrogate and plotted with unadjusted and risk-adjusted cumulative sum (CUSUM) analyses. Risk adjustment incorporated age, body mass index, ASA class, sex, prior abdominal surgery, diagnosis, anastomotic level, and the need for diverting loop ileostomy—used as a marker of case complexity rather than a direct time determinant. Phase-specific peri-operative outcomes were compared non-parametrically. Five proficiency phases were identified: Initial Learning (cases 1–10), Experienced (11–65), Second Learning (66–80), Advanced Experienced (81–124) and Mastery (125–170). The unadjusted CUSUM rose to + 342&#xa0;min above the cohort mean by case 10, crossed the baseline at case 55, then gradually declined and plateaued at approximately −215&#xa0;min by case 170. Risk-adjusted CUSUM displayed parallel inflection points (peak + 78&#xa0;min, nadir −162&#xa0;min), confirming that an easier case mix did not explain efficiency gains. Mean operative time fell from 248.8 ± 64.1&#xa0;min in the first phase to approximately 185&#xa0;min in Mastery, and inter-quartile variability narrowed from 125 to 59&#xa0;min. Intraoperative complications (overall 12.4%), blood loss, organ/space surgical site infection, and 30-day morbidity did not differ across phases (<i>p</i> &gt; 0.05). The robotic NICE procedure follows a five-phase learning curve, with true proficiency—and a 20% reduction in operative time—achieved after ~ 55 cases. Safety metrics remained similar across phases, confirming that efficiency gains reflect skill acquisition rather than easier case mix. These milestones can guide training for surgeons adopting the technique.</p>

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Assessing the learning curve in robot-assisted intracorporeal colorectal anastomosis and transrectal extraction (NICE) procedure: from Initial Learning to Mastery

  • 期刊论文

  • 发表日期：

    2025年6月17日

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  • Jacques Bistre-Varon,
  • Muhammed Elhadi,
  • Robert Wei,
  • Jimena Alcocer-Barrios,
  • Ryan Gunter,
  • Joshua Coursey,
  • Priya Prakash,
  • Erin McAtee,
  • Haley Lanser,
  • Rachel Ellsworth,
  • Matthew Weaver,
  • Jean-Paul LeFave,
  • Eric M. Haas

摘要

The robotic NICE procedure is a novel minimally invasive approach in colorectal surgery, yet its learning curve remains undefined; this study aimed to define its distinct phases by analyzing operative time trends. A retrospective review of 170 consecutive NICE procedures performed by a single surgeon between May 2018 and August 2019 was undertaken. Skin-to-skin operative time was the learning curve surrogate and plotted with unadjusted and risk-adjusted cumulative sum (CUSUM) analyses. Risk adjustment incorporated age, body mass index, ASA class, sex, prior abdominal surgery, diagnosis, anastomotic level, and the need for diverting loop ileostomy—used as a marker of case complexity rather than a direct time determinant. Phase-specific peri-operative outcomes were compared non-parametrically. Five proficiency phases were identified: Initial Learning (cases 1–10), Experienced (11–65), Second Learning (66–80), Advanced Experienced (81–124) and Mastery (125–170). The unadjusted CUSUM rose to + 342 min above the cohort mean by case 10, crossed the baseline at case 55, then gradually declined and plateaued at approximately −215 min by case 170. Risk-adjusted CUSUM displayed parallel inflection points (peak + 78 min, nadir −162 min), confirming that an easier case mix did not explain efficiency gains. Mean operative time fell from 248.8 ± 64.1 min in the first phase to approximately 185 min in Mastery, and inter-quartile variability narrowed from 125 to 59 min. Intraoperative complications (overall 12.4%), blood loss, organ/space surgical site infection, and 30-day morbidity did not differ across phases (p > 0.05). The robotic NICE procedure follows a five-phase learning curve, with true proficiency—and a 20% reduction in operative time—achieved after ~ 55 cases. Safety metrics remained similar across phases, confirming that efficiency gains reflect skill acquisition rather than easier case mix. These milestones can guide training for surgeons adopting the technique.