The influence of proficiency-based progression training on
peri-operative and survival outcomes in robot-assisted laparoscopic
surgery for endometrial cancer: an observational cohort study.
Objective To assess the influence of proficiency-based
progression (PBP) training in robot-assisted laparoscopic (RAL) surgery
for endometrial cancer on peri-operative and survival outcomes.
Design Observational cohort study. Setting Tertiary
referral and subspecialty training centre. Population All women
with primary endometrial cancer treated with RAL surgery between 2015
and 2022. Methods Proficiency-based progression training cases
were identified pre-operatively by consultant surgeons based on clinical
factors, such as BMI and comorbidities, and case complexity matching the
experience of the trainee. Main Outcome Measures Intra- and
post-operative complications, blood transfusions, readmissions
< 30 days, return to theatre rates and 5-year disease-free and
disease-specific survival for training versus non-training cases.
Results Training cases had a lower BMI than non-training cases
(30 versus 32 kg/m 2), but were comparable in age,
performance status and comorbidities. Training had no influence on
intra- and post-operative complications, blood transfusions,
readmissions < 30 days, return to theatre rates and median
5-year disease-free and disease-specific survival. Operating time was
longer in training cases (161 versus 137 min). Estimated blood loss,
conversion rates, CCU-admissions and lymphoedema rates were comparable.
Conclusions Proficiency based progression training can be
safely used to teach RAL surgery for women with endometrial cancer.
Prospective trails are needed to further investigate the influence of
distinct parts of RAL surgery performed by a trainee on endometrial