SynthesisJournal of robotic surgery2026
The Multi-Dimensional Learning Curve in Robotic-Assisted vs. Laparoscopic Rectal Cancer Resection: A Systematic Review of Procedural Efficiency, Pathological Integrity, and Ergonomic Impact.
Synthesis in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
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Abstract
The adoption of robotic-assisted surgery (RAS) for rectal cancer is governed by a steep learning curve (LC). This systematic review evaluates the "Price of Proficiency" by comparing RAS to conventional laparoscopic surgery (CLS) across temporal, oncological, and ergonomic dimensions. A systematic search of PubMed, Embase, and Scopus (2014-2026) identified 24 studies utilizing Cumulative Sum (CUSUM) or Risk-Adjusted CUSUM (RA-CUSUM) modeling. Methodological quality was appraised using MINORS and Cochrane RoB 2.0 tools. Synthesis of >3,500 procedures revealed a triphasic LC. Phase I (Learning: cases 1-25) demonstrated high operative times but remarkably low conversion rates (1.0%-3.2%) compared to historical CLS averages (12.2%- 15.0%). Technical proficiency (Phase II) stabilized by case 35, while Phase III (Mastery: >50 cases) was characterized by "Complexity Drift," where surgeons tackled high-BMI and post-radiation cases without compromising outcomes. Oncological quality, including TME completeness (91.9%-97.0%) and CRM negativity, remained stable throughout all LC phases. Mastery was associated with higher nodal yield and an increased likelihood of achieving a "Textbook Outcome". The robotic platform decouples procedural speed from surgical safety, providing an immediate "safety net" that protects oncological integrity during the initial learning phase. While RAS requires a significant temporal investment, its superior ergonomics and lower conversion rates support its transition as the standard for minimally invasive rectal cancer resection.
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Registered trials
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