Premium
The learning curve of robot‐assisted laparoscopic fundoplication in children: a prospective evaluation and CUSUM analysis
Author(s) -
Cundy Thomas P.,
Rowland Simon P.,
Gattas Nicholas E.,
White Alan D.,
Najmaldin Azad S.
Publication year - 2015
Publication title -
the international journal of medical robotics and computer assisted surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.556
H-Index - 53
eISSN - 1478-596X
pISSN - 1478-5951
DOI - 10.1002/rcs.1610
Subject(s) - cusum , learning curve , prospective cohort study , medicine , computer science , surgery , statistics , mathematics , operating system
Background Fundoplication is a leading application of robotic surgery in children, yet the learning curve for this procedure (RF) remains ill‐defined. This study aims to identify various learning curve transition points, using cumulative summation (CUSUM) analysis. Methods A prospective database was examined to identify RF cases undertaken during 2006–2014. Time‐based surgical process outcomes were evaluated, as well as clinical outcomes. Results A total of 57 RF cases were included. Statistically significant transitions beyond the learning phase were observed at cases 42, 34 and 37 for docking, console and total operating room times, respectively. A steep early learning phase for docking time was overcome after 12 cases. There were three Clavien–Dindo grade ≥ 3 complications, with two patients requiring redo fundoplication. Conclusions We identified numerous well‐defined learning curve trends to affirm that experience confers significant temporal improvements. Our findings highlight the value of the CUSUM method for learning curve evaluation. Copyright © 2014 John Wiley & Sons, Ltd.