A. S. Weltz1, N. Wu1, U. Sibia1, J. Chamu1, H. R. Zahiri1, I. Belyansky1 1Anne Arundel Medical Center,Minimally Invasive Surgery,Annapolis, MD, USA
Introduction:
We previously described a novel approach to transversus abdominus release (TAR) via laparoscopic technique. Use of robotic platform to address TAR has also been previously reported. Considering the complexity of anatomy and difficult technical aspects, both of these approaches are thought to be associated with a steep learning curve. We evaluate a single surgeon’s operative outcomes and early learning curve with laparoscopic and robotic TARs.
Methods:
Review of prospectively collected data for a single surgeon was performed for a consecutive series of thirty-two patients that underwent laparoscopic TAR (n=24) and robotic TAR (n=10) from August 2015- August 2016. A board-certified fellowship trained MIS surgeon, completed 40+ hours of simulation training on the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale CA) and additional cadaveric training prior to the start his robotic procedures. The learning curve was examined by averaging operating room (OR) times in intervals of 5 procedures.
Results:
Thirty-two patients (22 Lap TAR vs. 10 rTAR) with mean age (55.3 vs. 60.2 years, p=0.393), BMI (31.7 vs. 30.4 kg/m2, p=0.589) and ASA (2.4 vs. 2.4, p=0.930) were studied. Estimated blood loss (60.2 vs. 63.5 ml, p=0.758) and length of stay (2.3 vs 1.9 days, p=0.647) were equivalent. In laparoscopic TAR, operating room times (ORT) decreased from an average of 335.0 mins for the first five cases to 249.4 mins for the 6-10th cases (p=0.008). In robotic TAR cases ORT decrease from average 323.2 mins for first 5 cases to 220.4 mins for the 6th-10th cases (p=0.108). There was no significant difference in ORT when comparing laparoscopic vs robotic 6th-10th cases, 249.4 vs 220.4 mins (p=0.49) respectively. Significant decrease in ORT for laparoscopy was seen comparing 1st-5th vs 15th-20th cases, 335.0 vs 253.4 mins respectively (p=0.006), but no significant difference when comparing 6th-10th vs 15th-20th cases implying the saturation of the learning curve was achieved between 6th and 10th cases. Wound and non-wound related complications were equivalent at a mean follow up of 6 months.
Conclusion:
Our review of laparoscopic and robotic TAR experience revealed no difference in the learning curves when comparing laparoscopy to robotics in the hands of an MIS expert surgeon. Operative time revealed a significant downward ORT trend with an increased number of cases in both groups, with low morbidity.
