Building on last week’s CAVA blog, the literature has identified a learning curve of 25-90 cases required to be safe AND proficient, with the average surgeon at about 50 cases.
Likewise, simulation has been studied to shorten this initial learning curve by approximately 50% so that 20-25 cases is achievable. SAGES and urologic societies support the above findings with excellent studies showing docking time efficiency is achieved at 20-25 cases. Specimen margins, lymph nodes, blood loss, etc. have all been used as proxies for the learning curve and validate the above findings. ACOG committee opinion 628 also addresses this. Maintenance of skills have been less well documented, but it has been suggested at 12 to 50 cases and the AAGL has published 20 as the standard.
There are some excellent studies that show that at less than 20 cases per year, operative times (and therefore risk), EBL and complications all increase. When case volume are greater than 40 cases per year, all of these numbers fall to rates that are comparable with laparoscopic or open surgery. Simulator performance also deteriorates as the time between cases increases.