{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:57:08Z","timestamp":1791568628277,"version":"4.3.4"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 del Salento"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Robotic cholecystectomy (RC) has been increasingly adopted in general surgery; however, evidence on its role and performance within structured training programs remains limited. This study aimed to evaluate the learning curve and perioperative outcomes of RC in a high-volume teaching center. A single-center retrospective study was conducted in a high-volume teaching hospital including all consecutive RCs performed between October 2019 and April 2025 by surgeons and trainees without prior robotic experience. All procedures were carried out within a structured training program under senior supervision. The primary outcome was the learning curve, assessed using cumulative sum (CUSUM) analysis of operative time. Secondary outcomes included perioperative results and subgroup analyses according to operator type and patient-related factors. Multivariable regression analysis was performed to identify factors influencing operative time. A total of 441 patients were included. Mean operative time was 64\u2009\u00b1\u200921\u00a0min. No intraoperative injuries or conversions to open or laparoscopic surgery occurred. Postoperative complications were observed in 6 patients (1.4%), with a readmission rate of 0.9%. CUSUM analysis identified four phases: an initial variability phase (1\u201313 cases), a stabilization phase (14\u201330), a performance improvement phase (30\u201350), and a late plateau. Operative time was independently associated with adhesiolysis (B\u2009=\u20099.382;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and male sex (B\u2009=\u20097.139;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), whereas operator type was not significant. Outcomes were consistent across subgroups, including obesity and ASA class. Comparable learning patterns were observed between surgeons and trainees. In high volume training centers, RC can be safely implemented within surgical training programs, showing a relatively short learning curve and low complication rates. These findings support its use as a reproducible platform for robotic training and suggest its suitability as an entry-level procedure in robotic surgery.\n                  <\/jats:p>","DOI":"10.1007\/s11701-026-03558-4","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T01:28:17Z","timestamp":1782091697000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Robotic cholecystectomy during surgical training: learning curve and perioperative outcomes of 441 consecutive cases in a high-volume teaching center"],"prefix":"10.1007","volume":"20","author":[{"given":"Gianpiero","family":"Gravante","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Mita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amedeo","family":"Altamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria","family":"Barbieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Bianco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Benedicenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Catamer\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Clemente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Giaracuni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Grillea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Morelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arcangelo","family":"Picciariello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Puglisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Sorge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Rubichi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo Giuseppe","family":"Viola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"10","key":"3558_CR1","doi-asserted-by":"publisher","first-page":"2550","DOI":"10.1007\/s00268-016-3543-9","volume":"40","author":"T Leal Ghezzi","year":"2016","unstructured":"Leal Ghezzi T, Campos Corleta O (2016) 30 Years of Robotic Surgery. 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In accordance with institutional policies and national regulations, ethical approval was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from the participants included in the study for the conduction of surgery.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Informed consent"}},{"value":"This study provides a large, real-world evaluation of robotic cholecystectomy performed within a structured training program, including 441 consecutive cases by multiple surgeons and trainees without prior robotic experience. Results show that robotic cholecystectomy can be safely integrated into general surgery training as an entry-level robotic procedure when implemented within a structured program, high-volume setting, and appropriate case selection. The relatively short learning curve and excellent safety profile support its role as an effective platform for the acquisition of robotic skills.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Originality Statement"}}],"article-number":"628"}}