Study of learning curve for da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant

Exploring the learning curve of Da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant(RNSMIBR). The clinical data of 129 breast cancer patients completed from September 2022 to June 2024 in a single institution were retrospectively analyzed. The duration of operation was evaluated by cumulative sum analysis (CUSUM) to fit a learning curve. According to the critical value of the learning curve, the learning curve of da Vinci robotic mastectomy was divided into different stages. The patients' median age was 42.09 ± 7.3 years. In addition, the median operative of RNSMIBR time was 118.52 ± 65.3min. There was no conversion to laparoscopic or open surgery. Intraoperative complications were observed in 6.15 % of the procedures and the learning curve reached a level that would be considered acceptable in terms of failure rates. The optimal curve-fitting equation was: CUSUM = 0.002x3-0.773 × 2+58.491x+1144.242. A tendency of decline in total operative time following the first 27 cases was found. The CUSUM graph for total operative time indicated the generation of two distinct performance phases, namely learning (n = 27) and proficiency (n = 102). The minimum number of operations required for surgeons to reach the competence and proficiency stages of the learning curve is 27. This learning curve can be used as a basis for performance guidance during the training of young surgeons in the future.