Safety and Learning Curve of Robotic Rectal Surgery Performed by Young Non-Endoscopic Surgical Skill Qualification System (ESSQS)-Qualified Surgeons: A Single-Center Retrospective Study

Background: The number of robotic rectal surgeries being performed in Japan is rapidly increasing. Therefore, the training of young surgeons in robotic rectal surgery has received significant attention. We herein examined the safety and short-term clinical outcomes of robotic rectal surgery performed by young non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons. Methods: Patients who underwent robotic surgery for rectal cancer between November 2019 and October 2023 were included. Robot-assisted rectal surgeries were performed from February 2022 by two young non-ESSQS-qualified surgeons. Young surgeons were defined as those within 12 years after medical graduation. The clinical outcomes of robotic rectal surgery performed by non-ESSQS-qualified surgeons and by qualified surgeons were evaluated. Patients who received preoperative chemoradiotherapy or required complex procedures were excluded. Results: A total of 269 patients underwent robotic surgery for rectal cancer, and 178 were investigated. We included 35 (19.7%) and 143 (80.3%) patients who underwent robotic surgery by non-ESSQS-qualified surgeons and qualified surgeons, respectively. Median total operative time was longer in the non-qualified group (334 vs. 285 minutes, p<0.001), but postoperative complication rates (6% vs. 10%, p=0.67) and hospital stay (10 vs. 10 days, p=0.85) were similar. Conclusions: Robotic rectal surgery by young non-ESSQS-qualified surgeons appears feasible with acceptable short-term outcomes, though longer operative times and the need for proctor supervision should be considered.