Robotic versus laparoscopic intracorporeal anastomosis learning curve: a systematic review

Dhadlie, S; Larkins, K; Fay, T; Proud, D; Warrier, S; Heriot, A; Mohan, H

Author(s): Dhadlie, S; Larkins, K; Fay, T; Proud, D; Warrier, S; Heriot, A; Mohan, H;
Details: Publication Year 2026-05-13,Volume 20,Issue #1,Page 487
Journal Title: Journal of Robotic Surgery
Publication Type: Review
Abstract: The learning curve for robotic colorectal surgery is increasingly characterised. However, the specific learning curve for intracorporeal anastomosis (IA) remains poorly defined. This review compares robotic and laparoscopic IA with respect to operative time, cases required for proficiency, complication rates, and conversion to extracorporeal anastomosis (EA). A systematic review was conducted in accordance with PRISMA guidelines. The protocol was registered on Open science framework ( https://doi.org/10.17605/OSF.IO/K4MYZ ). On March 18, 2025, OVID and PubMed were searched using the search terms; "laparoscopic," "robotic," "anastomosis," "learning," "education," and "training." Yielding a total of 273 results from PubMed (179) and OVID (94). After screening a total of thirteen studies were included. Thirteen studies met inclusion criteria, including eight comparative analyses and six directly comparing robotic and laparoscopic techniques. Four studies evaluated robotic learning curves without a comparator group, while one was a literature review incorporating institutional experience. Most studies were retrospective (n = 8), with two prospective clinical studies and two experimental simulation-based studies. Hybrid approaches (robotic mobilisation with laparoscopic EA) contributed to heterogeneity (Reitz et al. 2018, https://doi.org/10.1007/s00464-018-6074-7 ). Learning curve assessment was heterogeneous, with most studies using cumulative sum (CUSUM) or risk-adjusted CUSUM (RA-CUSUM) analyses based on operative time or technical performance metrics. Proficiency in robotic IA was reported after approximately 11-29 cases in some series and around 20 cases in others, although larger studies of robotic colorectal surgery demonstrated broader ranges of up to 100 cases. Robotic right hemicolectomy with IA demonstrated a shorter learning curve and reduced anastomosis time compared with laparoscopic IA. Complication rates, conversion rates, and oncological outcomes were comparable between approaches (Gachabayov et al. 2019, Surg Technol Int, 34:163-168). Robotic intracorporeal anastomosis, particularly in right hemicolectomy, appears to have a shorter and less technically demanding learning curve compared with laparoscopic techniques, without compromising safety or oncological outcomes. These findings support a potential role for robotic platforms in facilitating adoption of intracorporeal anastomosis. However, current evidence is limited by retrospective design, small cohorts, and inconsistent definitions of proficiency (Gachabayov et al. 2019, Surg Technol Int, 34:163-168; Van Eetvelde et al. 2022, https://doi.org/10.1007/s11701-022-01514-6 ).
Publisher: Springer Nature
Keywords: Humans; *Learning Curve; *Robotic Surgical Procedures/education/methods; *Laparoscopy/education/methods; *Anastomosis, Surgical/methods/education; Operative Time; Clinical Competence; Intracorporeal anastomosis; Learning curve; Minimally invasive colorectal surgery; Robotic colorectal surgery; Robotic surgery; Surgical training
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.1007/s11701-026-03468-5
Open Access at Publisher's Site: https://doi.org/10.1007/s11701-026-03468-5
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-05-28 04:25:03

Last Modified: 2026-05-28 04:25:26