Learning curve of consolers and bedside surgeons fused robotic-assisted thoracoscopic segmentectomy: insights from the initial 100 cases

Purpose: This study examined the learning curve of segmentectomy using the "fused surgery" approach.

Methods: We retrospectively collected data from 100 patients who underwent segmentectomy via fused robot-assisted thoracoscopy at our institution between September 2020 and February 2024. The learning curve was evaluated using the cumulative sum of the operative times in all cases and was analyzed separately for simple and complex segmentectomies.

Results: After applying the cumulative sum method to all cases, we obtained a graph of the operative time that showed three well-differentiated phases: phase 1 (n = 23), the initial learning phase; phase 2 (n = 28), the increased competence phase; and phase 3 (n = 49), the highest skill phase. Comparing phases 1 and 2 with phase 3, we found significant differences in operative time (P < 0.001); however, no significant differences were observed in bleeding or rate of postoperative complications. We observed a significant reduction in operative time after 25 simple segmentectomies and 22 complex segmentectomies.

Conclusions: The data suggested that the inflection point of the learning curve was achieved in 51 cases. Complex segmentectomy requires the same cases to achieve the same level of competence as simple segmentectomy.