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.