Short-term clinical outcomes of a European training programme for robotic colorectal surgery

Abstract

Background Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery—EARCS). Methods Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. Results Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. Conclusions Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.

Robotic right colectomy with complete mesocolic excision: Senior versus junior surgeon, a case‐matched retrospective analysis

“…The novice had completed a structured training programme for RRC that is mandatory and required when dealing with technically demanding procedures to ensure patient safety. 16,20,21 The training programme experienced by the junior surgeon started as a surgical resident, including more than 100 RRCs as table assistants and practice with robotic simulation software and inanimate and animal models. Then, he entered a structured tutoring programme for RRC consisting of a diversified path for increasingly difficult tasks (colon mobilization, IA, and vascular control), each performed at least twice under supervision.…”

“…Of note, in contrast to the present study, all of the surgeries were performed by established specialist colorectal surgeons, and the trainees (n = 323/ 1130 procedures) were always supervised by an expert mentor (>200 colorectal robotic resections). 16 The possibility that a robot reduces the right colectomy learning curve has already been reported, showing a lower conversion rate and greater use of the IA technique. 15 The evidence suggests that approximately 15-30 cases are needed to complete the learning curve in robotic colorectal surgery training, compared to 60-80 for the laparoscopic technique, 11 but the figures are highly variable among different studies.…”

“…The learning curve in robotic surgery is a multifactorial process related to multiple aspects, such as prior experience and background in conventional laparoscopy and defined specialities (i.e., colorectal surgery). In addition, having obtained proficiency with this technology through appropriate and structured training in a high‐volume centre is of utmost importance to reduce the risk of complications during the learning process 16 . To date, few studies have focussed on the surgical training pathway used to gain competence in colorectal robotic surgery 16–19 .…”

“…In addition, having obtained proficiency with this technology through appropriate and structured training in a high-volume centre is of utmost importance to reduce the risk of complications during the learning process. 16 To date, few studies have focussed on the surgical training pathway used to gain competence in colorectal robotic surgery. [16][17][18][19] Moreover, no studies have directly compared the outcomes of a skilled surgeon versus a junior surgeon with no prior robotic colorectal surgery experience.…”

“…16 To date, few studies have focussed on the surgical training pathway used to gain competence in colorectal robotic surgery. [16][17][18][19] Moreover, no studies have directly compared the outcomes of a skilled surgeon versus a junior surgeon with no prior robotic colorectal surgery experience.…”