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.
AA Sickinghe1,2
MAE Nobbenhuis1
EJT Nelissen1
O M Heath1
TEJ Ind1
1Department of Gynaecological Oncology, Royal Marsden
Hospital, London, United Kingdom
2Faculty of Medicine, Utrecht University and
University Medical Centre Utrecht, Utrecht, The Netherlands
Correspondence to: TEJ Ind, Department of Gynaecological Oncology, Royal
Marsden Hospital, Fulham Road, London SW3 6JJ, United Kingdom. Email:
Thomas.Ind@rmh.nhs.uk.
Running title: the effect of training in RAL surgery on endometrial
cancer outcomes.
AbstractObjective 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/m2), 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
cancer outcomes.
Funding None
Keywords Endometrial cancer, robot-assisted laparoscopic
surgery, progression-based proficiency training, peri-operative
outcomes, post-operative outcomes survival.