Robot-assisted thoracic surgery (RATS): learning curve and outcomes for 200 consecutive pulmonary lobectomies in a Norwegian hospital

Abstract

Background: When starting with new surgical procedures, a gradual improvement in skills and results is expected. Pulmonary resection for early-stage non-small cell lung cancer (NSCLC) has advanced with technology, making robot-assisted thoracic surgery (RATS) an increasingly preferred method. At Akershus University Hospital (Ahus), exploring the learning curve associated with RATS offered valuable insights for optimizing surgical efficiency and improving patient outcomes. This study analyzes key operational variables and outcomes to highlight the skill acquisition process at a leading Norwegian healthcare center, aiming to describe the learning curve involved in transitioning from video-assisted thoracic surgery (VATS) to RATS for lung cancer lobectomies. Methods: This study was a retrospective analysis of the first 200 consecutive pulmonary lobectomies and bi-lobectomies with RATS in Norwegian University Hospital. We used cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses to evaluate operative times and perioperative complications. Results: procedure. Conclusions: The findings suggest that the transition from VATS to RATS as a standard surgical approach for pulmonary lobectomies was associated with an acceptable development of proficiency, procedure duration, and complication rates over time. Hence, implementation of the new RATS program was feasible and effective.