Do Surgical Trainees Impact Surgeon Robotic Learning Curves?

Inter-surgeon variability in robotic surgery learning curves, as well as the impact of trainee involvement and the presence or absence of a formal robotic training curriculum, remain poorly defined. Cumulative sum (CUSUM) analysis is a validated method for evaluating learning curves in robotic surgery. Our study aimed to utilize CUSUM analysis to explore whether surgical trainees affect surgical operating times. We retrospectively analyzed robotic-assisted cholecystectomies performed by 7 surgeons at a single academic institution between 2012 and 2022. A robotic surgery curriculum was implemented in 2016. Cases were ordered chronologically for each surgeon, and CUSUM learning curves were generated using operative time as the outcome. The first peak in the CUSUM curve indicated the completion of the learning phase. Trainee involvement was analyzed by postgraduate year. 707 operations were performed. Five surgeons demonstrated a distinct learning phase, with a learning phase ranging from 20 to 59 cases, whereas two surgeons exhibited baseline proficiency without an identifiable learning phase. Despite consistently high trainee participation (94.5% of cases) and similar distributions of trainee seniority, learning curve variability persisted. Implementation of an institutional robotic training curriculum was not associated with abrupt changes in learning curve trajectories among surgeons. Learning curves in robotic-assisted cholecystectomies are highly variable and surgeon-specific. Implementation of the robotic training program did not influence the overall trajectory of the surgeon's personal learning phase.