Learning curve of totally endoscopic non-robotic resection of left atrial myxoma

Objective: This study aimed to evaluate the learning curve associated with totally endoscopic resection of left atrial myxomas performed without robotic assistance. Methods: A retrospective descriptive study was conducted on 44 patients diagnosed with left atrial myxoma who underwent totally endoscopic, non-robotic surgery at the Cardiovascular Center, E Hospital, between January 2019 and January 2024. Patients were chronologically divided into two cohorts: an early group of 22 patients (January 2019 – June 2021) and a late group of 22 patients (July 2021 – January 2024). Results: The operative time in the late group was significantly shorter than in the early group (3.8 ± 0.8 vs. 4.4 ± 0.7 hours; p < 0.05). Cardiopulmonary bypass and aortic cross-clamp times exhibited downward trends across consecutive cases, although these differences were not statistically significant. CUSUM analysis showed a substantial decline and subsequent stabilization in cumulative performance after approximately the 30th case. No mortality, recurrence, or conversion to sternotomy was observed in the entire cohort. Conclusion: Totally endoscopic, robot-free resection of left atrial myxomas is feasible, safe, and effective. Surgical performance improves notably with accumulated operative experience.