The Learning Curve in Minimally Invasive Right Colectomy: Challenges, Metrics, and Future Perspectives, a Systematic Review.

INTRODUCTION: Minimally invasive right colectomy (MIRC) is the gold standard for the treatment of right-sided colonic diseases, particularly in cancer patients. However, mastering this procedure requires overcoming a significant learning curve (LC). This systematic review (SR) analyzes existing evidence on LC in MIRC. METHODS: This SR was conducted according to the PRISMA guidelines. The PubMed, Scopus, EMBASE, and Cochrane Library databases were screened without time restrictions up to June 2024. The risk of bias was assessed for individual studies according to the ROBINS-I tools, while the certainty of the evidence was assessed according to the GRADE approach. The protocol was registered on PROSPERO (ID: CRD42024507060). RESULTS: Nine cohort studies published between 2005 and 2022 met the inclusion criteria. The median number of cases needed to overcome the LC for MI-RC was 26 (range 13-55), 25 (range 18-55) procedures for the laparoscopic, and 27 (range 13-44) for the robotic approach. The comparison between the learning and the proficiency phase shows a significant reduction of operative time (MD: -41.51 min; p = 0.0027) and postoperative morbidity (OR = 0.49; p = 0.043) after the LC was achieved. No differences were detected in the estimated blood loss (MD: -3.3 mL; p = 0.77), whit a significantly high heterogeneity (I2 = 68.8%). CONCLUSIONS: The lack of standardization in defining and assessing the LC contributes to the heterogeneity of findings among studies. The development of standardized guidelines is essential to improve colorectal surgical training.