Learning curve analysis of laparoscopic low anterior resection using the ArtiSential multi-articulating device: a multicenter retrospective cohort study with pooled analysis (STARC trial).

PURPOSE: Robotic surgery has shown promising outcomes in colorectal cancer treatment but is limited by its high cost. In response, the ArtiSential system (LivsMed Inc.), an articulated handheld laparoscopic instrument, has emerged as an alternative. This study aimed to assess the learning curve associated with ArtiSential during low anterior resection (LAR) of colorectal cancer. METHODS: A multicenter retrospective cohort study enrolled 208 patients who underwent LAR with ArtiSential between January 2021 and October 2022. A cumulative sum (CUSUM) analysis was conducted for operation time. Three experienced surgeons, each with over 30 completed ArtiSential-assisted LAR procedures, were included in the analysis. RESULTS: The median operation time was 129 minutes; it was accompanied by minimal blood loss and no open conversions. Pathological analysis revealed favorable outcomes with high-quality total mesorectal excision and a circumferential resection margin. Surgeons A and B followed a conventional 4-stage learning curve, achieving mastery after 25 and 24 cases, respectively. In contrast, surgeon C demonstrated a unique 2-stage learning curve, achieving mastery after 19 cases. CONCLUSION: The CUSUM analysis suggests a relatively manageable learning curve, with the initial phase being completed after approximately 10 cases and proficiency attained after 20-30 cases. In conclusion, ArtiSential appears to be a promising tool for colorectal surgeons, offering a favorable learning curve and encouraging outcomes in LAR for rectal cancer.