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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.
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  • Ilse Baeten,
  • Jacob P. Hoogendam,
  • Henk Schreuder,
  • Ina Jürgenliemk-Schulz,
  • Kees Gerestein,
  • Ronald Zweemer
Ilse Baeten
Universitair Medisch Centrum Utrecht

Corresponding Author:[email protected]

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Jacob P. Hoogendam
Universitair Medisch Centrum Utrecht
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Henk Schreuder
Universitair Medisch Centrum Utrecht
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Ina Jürgenliemk-Schulz
Universitair Medisch Centrum Utrecht
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Kees Gerestein
Universitair Medisch Centrum Utrecht
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Ronald Zweemer
Universitair Medisch Centrum Utrecht
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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.