Background: Recent publications suggest that the threshold for validation of the learning curve is 25 procedures. The aim of this study was to evaluate this threshold using another rarely used method, based on a composite quality indicator. Methods: We included all patients from the French medico-administrative database receiving robot-assisted surgery for lung cancer, with a focus on hospitals performing at least 25 procedures over the period 2019–2022. For postoperative complication analysis, we used the Clavien–Dindo classification. We used the sequential probability ratio test to estimate the number of procedures at which a hospital achieved its learning curve. Results: In France, the number of robotic-assisted procedures has risen steadily in the past few years: 195 in 2019 and 1567 in 2022 (overall, 3706 Robot-Assisted surgeries). The total number of patients with Clavien–Dindo classification > II was 833 (24.7%). Among the 28 hospitals performing at least 25 procedures, eight achieved their learning curve with thresholds ranging from 94 to 174 procedures, and the median was 110. Severe complications such as acute respiratory distress syndrome, respiratory failure, heart failure, acute ischemia of the lower limbs, or pulmonary embolism were significantly more frequent in the group of hospitals that did not validate the learning curve threshold. Conclusions: This study suggests that the threshold of 25 procedures may not be sufficient to validate the robot-assisted surgery learning curve in lung cancer surgery. To significantly reduce postoperative complications, a hospital would need to perform 94 to 174 procedures to guarantee patient safety.

Evaluate theoretical and practical training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) in France. A survey was distributed to thoracic surgeons-in-training in France from November 2022 to February 2023. We recruited 101 thoracic surgeons-in-training (77% response rate). Over half had access to a surgical robotics system at their current institution. Most (74%) considered robotic surgery training essential, 90% had attended a robotic procedure. Only 18% had performed a complete thoracic robotic procedure as the main operator. A complete RATS procedure was performed by 42% of fellows and 6% of residents. Of the remaining surgeons, 23% had performed part of a robotic procedure. Theoretical courses and simulation are well developed; 72% of residents and 91% of fellows had undergone simulation training in the operating room, at training facilities, or during congress amounting to 30 h (3%). Access to RATS was ≥1 day/week in 71% of thoracic departments with robotic access. Fellows spent a median of 2 (IQR 1–3) semesters in departments performing robotic surgery. Compared with low-volume centres, trainees at high-volume centres performed significantly more complete robotic procedures (47% vs 13%; P = 0.001), as did fellows compared with residents. Few young surgeons perform complete thoracic robotic procedures during practical training, and access remains centre dependent. Opportunities increase with seniority and exposure; however, increasing availability of robotic devices, theoretical formation, and simulation courses will increase opportunities.

Background: Recent publications suggest that the threshold for validation of the learning curve is 25 procedures. The aim of this study was to evaluate this threshold using another method which is little used, based on a composite quality indicator. Methods: We included all patients from the French medico-administrative database receiving robot-assisted surgery for lung cancer between 2019 and 2022 in hospitals performing at least 25 procedures. For postoperative complications analysis we used the Clavien-Dindo classification. We used the sequential probability ratio test to estimate the number of procedures from which a team achieved its learning curve. Results: In France, the number of robotic-assisted procedures has risen steadily over the years: 195 in 2019 and 1,567 in 2022: overall, 28 teams performed 3,707 Robot-Assisted surgery for lung cancer. The total number of patients with Clavien-dindo classification > II was 833 (24.7%). Among the 28 hospitals, 8 achieved their learning curve with a threshold ranging from 94 to 174 procedures, and a median of 110. Severe complications such as acute respiratory distress syndrome, respira-tory failure, heart failure, acute ischemia of the lower limbs and pulmonary embolism were signif-icantly more frequent in the group of hospitals that did not validate the learning curve threshold. Conclusion: This study suggests that the threshold of 25 procedures may not be sufficient enough to validate the robot-assisted surgery learning curve in lung cancer surgery. To significantly re-duce postoperative complications, a team would need to perform between 94 to 174 procedures to guarantee patient safety.