Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes

Abstract

Introduction: Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery.

Methods: A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st-40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes.

Results: More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001).

Conclusions: As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.

Keywords: extra arm; learning curve; robot‐assisted laparoscopic rectal surgery.