How Does the Surgeons Experience of Abdominal Operations Influence the Learning Curves for Robot-Assisted Vascular Anastomosis?

Soga, Shingo MD; Watanabe, Go MD, PhD; Ishikawa, Norihiko MD, PhD; Kimura, Keiichi MD, PhD; Oda, Makoto MD, PhD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: November/December 2013 - Volume 8 - Issue 6 - p 427–432
doi: 10.1097/IMI.0000000000000034
Original Articles

Objective: Endoscopic vascular anastomosis of abdominal aortic aneurysms is rarely performed and requires standardization. Here, we examined the impact of the surgeon’s experience of abdominal aortic aneurysm surgery on the learning curve for robot-assisted endoscopic vascular anastomosis.

Methods: Three vascular surgeons with more than 10 years’ experience (group A), three vascular surgeons with less than 10 years’ experience (group B), and three medical students with no experience (group C) of performing vascular surgery used the da Vinci surgical system to anastomose 8-mm–diameter vascular prostheses in an end-to-end manner with continuous 5–0 Prolene sutures. The procedure was performed five times by each participant. Outcomes were anastomosis time, number of actions, visual score, and pressure test. Snapping of the prolene thread was recorded as a procedural failure.

Results: Procedural failure occurred only in group C (3/15 trials, 20%; P < 0.0001). Learning curves were apparent in all three groups for anastomosis time and in groups A and C for the number of actions. Between trials 1 and 5, learning curves were apparent in all three groups for anastomosis time and in groups A and C for the number of actions but were not apparent for leakage or visual score in any group. Visual score and leakage were not significantly different among the three groups in each trial (P = 0.10 and P = 0.45, respectively).

Conclusions: By using the da Vinci surgical system, experienced vascular surgeons and surgically naive students showed marked improvements in vascular anastomosis techniques with a short period of training.

From the Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Kanazawa, Japan.

Accepted for publication September 20, 2013.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Go Watanabe, MD, PhD, Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan. E-mail: watago6633@gmail.com.

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery