Mentorship and formal robotic proficiency skills curriculum improve subsequent generations' learning curve for the robotic distal pancreatectomy.

Autor:	Al Abbas AI; University of Pittsburgh Medical Center, Pittsburgh, PA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA., Wang C; Northshore University Healthsystem, Evanston, IL, USA., Hamad AB; Ohio State University Medical Center, Columbus, OH, USA., Knab LM; University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Rice MK; University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Moser AJ; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA., Zeh HJ 3rd; University of Texas Southwestern Medical Center, Dallas, TX, USA., Zureikat AH; University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Hogg ME; Northshore University Healthsystem, Evanston, IL, USA. Electronic address: mhogg@northshore.org.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2021 Dec; Vol. 23 (12), pp. 1849-1855. Date of Electronic Publication: 2021 May 05.
DOI:	10.1016/j.hpb.2021.04.022
Abstrakt:	Background: Minimally invasive distal pancreatectomy is the accepted standard of care. The robotic distal (RDP) learning curve is 20-40 surgeries with operating time (ORT) as the most significant factor. This study evaluates how formal mentorship and a robotic skills curriculum impact the learning curve for subsequent generation surgeons. Methods: Consecutive RDP from 2008 to 2017 were evaluated. First Generation was two surgeons who started program without training or mentorship. Second Generation was the two surgeons who joined the program with mentorship. Third Generation was fellows who benefited from both formal training and mentorship. Multivariable models (MVA) were performed for ORT, clinically relevant pancreatic fistula (CR-POPF), and major complications (Clavien≥3). Results: A total of 296 RDP were performed of which 187 did not include other procedures: First Generation (n = 71), Second Generation (n = 50), and Third Generation (n = 66). ORT decreased by generation (p < 0.001) without any differences in CR-POPF or Clavien≥3. On MVA, earlier generation (p = 0.019), pre-operative albumin (p = 0.001) and pancreatic adenocarcinoma (p = 0.019) were predictive of ORT. Increased BMI (p = 0.049) and neoadjuvant therapy (p = 0.046) were predictive of CR-POPF. Fellow participation at the console increased over time. Conclusion: Formal mentorship and a skills curriculum decreased the learning curve and complications were largely dependent on patient factors. (Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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