Yasunori Otowa, Hiroshi Hasegawa, Masayuki Ando, Kazumasa Horie, Morito Nishii, Yasufumi Koterazawa, Yutaka Sugita, Taro Ikeda, Tomoaki Aoki, Hitoshi Harada, Naoki Urakawa, Hironobu Goto, Shingo Kanaji, Takeru Matsuda
There was underreporting of demographic data, especially race and ethnicity of participants, a lack of demographic-specific study outcomes and underrepresentation of women and non-white participants across RCTs. This study highlights the need for greater efforts to improve diversity in robotic surgery clinical trials.
BACKGROUND: The learning curve plays a central role in determining operative efficiency in robotic colorectal surgery. With the emergence of multiple robotic platforms, including the da Vinci and the hinotori systems, it remains unclear whether operative efficiency during the early phase of program adoption is influenced more by platform-specific characteristics or by cumulative institutional experience.
METHODS: This single-center retrospective study included 46 consecutive patients who underwent robot-assisted right-sided colectomy, including right hemicolectomy and ileocecal resection (27 da Vinci; 19 hinotori). Console time was defined as the duration of robotic console manipulation and was log-transformed for regression analyses. Factors associated with console time were evaluated using univariable and multivariable linear regression analyses. The correlation between console time and total operative time was assessed using Pearson's correlation coefficient.
RESULTS: No statistically significant differences in measured patient characteristics were observed between the two groups. Neither total operative time nor console time differed significantly between the two platforms, whereas docking time was longer with the hinotori system (13 vs 8 min, P < 0.001). In univariable analyses, robotic platform and operation method were not significantly associated with console time and did not meet the prespecified criterion for inclusion in the multivariable model. In the multivariable analysis, cumulative case number remained associated with shorter console time (β = -0.033 per 10 cases, 95% CI -0.064 to -0.001; P = 0.043). Console time demonstrated a strong positive correlation with total operative time (r = 0.719, P < 0.001).
CONCLUSIONS: Cumulative institutional experience was associated with shorter console time in robot-assisted right-sided colectomy. However, because robotic platform introduction and accumulated experience were inherently related over time in this sequential platform adoption setting, their individual effects could not be fully disentangled. These findings should be interpreted as hypothesis-generating.