Procedure-specific Training for Robot-assisted Distal Pancreatectomy. Issue 1 (July 2021)

• Record Type: Journal Article
• Authors: Klompmaker, Sjors; van der Vliet, Walderik J.; Thoolen, Stijn J.; Ore, Ana Sofia; Verkoulen, Koen; Solis-Velasco, Monica; Canacari, Elena G.; Kruskal, Jonathan B.; Khwaja, Khalid O.; Tseng, Jennifer F.; Callery, Mark P.; Kent, Tara S.; Moser, A. James
• Is Part Of: Annals of surgery. Volume 274:Issue 1(2021)
• Publication Date: 2021-07
• Subjects: cohort study -- comparative effectiveness -- distal pancreatectomy -- laparoscopic surgery -- pancreas -- pancreatic disease -- pancreatic tail -- robotic surgery -- single-center -- surgery -- surgical training -- training program; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003291
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. Background: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. Methods: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only; June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensity-score-matched (1:1) analysis to determine clinical efficacy. Results: After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (−255 mL, P <0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (−1 day, P < 0.001). All other outcomes remained similar ( P >0.05). Over time, there were nonrandom ( P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31–65), and a steady-state (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. Conclusion: Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety. Abstract : Supplemental Digital Content is available in the text