Introducing a novice surgeon to an experienced robotic gynaecological
oncology team: an observational cohort study on the impact of a
structured curriculum on outcomes of cervical cancer surgery.
Abstract
Objective Effect on patient outcomes when introducing a novice
robotic surgeon, trained in accordance with a structured learning
curriculum, to an experienced robotic surgery team. Design
Observational cohort study. Setting Tertiary referral centre.
Population Patients with early-stage cervical cancer who were
treated with primary robot-assisted surgery between 2007 and 2019. In
addition to the 165 patients included in a former analysis, we included
a further 61 consecutively treated patients and divided all patients
over three groups: early learning phase of 61 procedures (group 1),
experienced phase of the 104 procedures thereafter (group 2), and the
final 61 procedures during introduction of a novice with structured
training (group 3). Methods Risk-adjusted cumulative sum
(RA-CUSUM) analysis was performed and patient outcomes between groups
were compared. Main Outcome Measures Surgical proficiency based
on recurrence, surgical and oncological outcomes. Results Based
on RA-CUSUM analysis, no learning curve effect was observed for group 3.
Regarding surgical outcomes, mean operation time in group 3 was
significantly shorter than group 1 ( p<0.001) and
similar to group 2 ( p=0.96). Proportions of intraoperative and
postoperative adverse events in group 3 were not significantly different
from the experienced group (group 2). Regarding oncological outcomes,
the 5-year disease-free survival, disease-specific survival, and overall
survival in group 3 were not significantly different from the
experienced group. Conclusions Introducing a novice robotic
surgeon, who was trained in accordance with a structured learning
curriculum, resulted in similar patient outcomes as by experienced
surgeons suggesting novices can progress through a learning phase
without compromising outcomes of cervical cancer patients.