PDF(Pubmed)
Abstract：
UNASSIGNED: Over the last decade there has been a transition from traditional laparoscopy to robotic surgery for the treatment of endometrial cancer. A number of gynecological oncology surgical fellowship programmes have adopted robot-assisted laparoscopy, but the effect of training on complications and survival has not been evaluated. Our aim was to assess the impact of a proficiency-based progression training curriculum in robot-assisted laparoscopy on peri-operative and survival outcomes for endometrial cancer.
UNASSIGNED: This is an observational cohort study performed in a tertiary referral and subspecialty training center. Women with primary endometrial cancer treated with robot-assisted laparoscopic surgery between 2015 and 2022 were included. Surgery would normally include a hysterectomy and salpingo-oophorectomy with some form of pelvic lymph node dissection (sentinel lymph nodes or lymphadenectomy). Training was provided according to a training curriculum which involves step-wise progression of the trainee based on proficiency to perform a certain surgical technique. Training cases were identified pre-operatively by consultant surgeons based on clinical factors. Case complexity matched the experience of the trainee. Main outcome measures were intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Mann-Witney U, Pearson\'s chi-squared, multivariable regression, Kaplan-Meier and Cox proportional hazard analyses were performed to assess the effect of proficiency-based progression training on peri-operative and survival outcomes.
UNASSIGNED: Training cases had a lower BMI than non-training cases (30 versus 32 kg/m2, p = 0.013), 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 theater rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min, p = < 0.001). The range of estimated blood loss was smaller in training cases. Conversion rates, critical care unit-admissions and lymphoedema rates were comparable.
UNASSIGNED: Proficiency-based progression training can be used safely to teach robot-assisted laparoscopic surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of robot-assisted laparoscopic surgery performed by a trainee on endometrial cancer outcomes.
UNASSIGNED: This is an observational cohort study performed in a tertiary referral and subspecialty training center. Women with primary endometrial cancer treated with robot-assisted laparoscopic surgery between 2015 and 2022 were included. Surgery would normally include a hysterectomy and salpingo-oophorectomy with some form of pelvic lymph node dissection (sentinel lymph nodes or lymphadenectomy). Training was provided according to a training curriculum which involves step-wise progression of the trainee based on proficiency to perform a certain surgical technique. Training cases were identified pre-operatively by consultant surgeons based on clinical factors. Case complexity matched the experience of the trainee. Main outcome measures were intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Mann-Witney U, Pearson\'s chi-squared, multivariable regression, Kaplan-Meier and Cox proportional hazard analyses were performed to assess the effect of proficiency-based progression training on peri-operative and survival outcomes.
UNASSIGNED: Training cases had a lower BMI than non-training cases (30 versus 32 kg/m2, p = 0.013), 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 theater rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min, p = < 0.001). The range of estimated blood loss was smaller in training cases. Conversion rates, critical care unit-admissions and lymphoedema rates were comparable.
UNASSIGNED: Proficiency-based progression training can be used safely to teach robot-assisted laparoscopic surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of robot-assisted laparoscopic surgery performed by a trainee on endometrial cancer outcomes.
摘要：
在过去的十年中，已经从传统的腹腔镜检查过渡到机器人手术治疗子宫内膜癌。许多妇科肿瘤外科研究金计划都采用了机器人辅助腹腔镜检查，但训练对并发症和生存率的影响尚未评估。我们的目的是评估机器人辅助腹腔镜检查中基于熟练程度的进展培训课程对子宫内膜癌围手术期和生存结果的影响。
■这是一项在三级转诊和亚专科培训中心进行的观察性队列研究。纳入2015年至2022年间接受机器人辅助腹腔镜手术治疗的原发性子宫内膜癌妇女。手术通常包括子宫切除术和输卵管卵巢切除术，并进行某种形式的盆腔淋巴结清扫术（前哨淋巴结或淋巴结清扫术）。根据培训课程提供培训，该培训课程涉及基于熟练程度执行某种手术技术的受训者的逐步发展。根据临床因素，由顾问外科医生在术前确定培训病例。案例复杂性与受训者的经验相匹配。主要结局指标为术中、术后并发症,输血,再入院<30天，训练与非训练病例的恢复率和5年无病生存率和疾病特异性生存率。Mann-WitneyU,皮尔森的卡方，多元回归，进行了Kaplan-Meier和Cox比例风险分析，以评估基于熟练程度的进展培训对围手术期和生存结果的影响。
■训练案例的BMI低于非训练案例（30对32kg/m2，p=0.013），但年龄相当，绩效状况和合并症。培训对术中和术后并发症没有影响，输血,再入院<30天，回到剧院率和5年无病生存率和疾病特异性生存率中位数。在训练情况下，手术时间更长(161对137分钟，p=<0.001)。在训练情况下，估计的失血范围较小。转化率,重症监护病房入院率和淋巴水肿率具有可比性.
■基于技能的进展培训可以安全地用于指导患有子宫内膜癌的女性的机器人辅助腹腔镜手术。需要进行前瞻性研究，以进一步研究受训者进行的机器人辅助腹腔镜手术的不同部分对子宫内膜癌结局的影响。
■这是一项在三级转诊和亚专科培训中心进行的观察性队列研究。纳入2015年至2022年间接受机器人辅助腹腔镜手术治疗的原发性子宫内膜癌妇女。手术通常包括子宫切除术和输卵管卵巢切除术，并进行某种形式的盆腔淋巴结清扫术（前哨淋巴结或淋巴结清扫术）。根据培训课程提供培训，该培训课程涉及基于熟练程度执行某种手术技术的受训者的逐步发展。根据临床因素，由顾问外科医生在术前确定培训病例。案例复杂性与受训者的经验相匹配。主要结局指标为术中、术后并发症,输血,再入院<30天，训练与非训练病例的恢复率和5年无病生存率和疾病特异性生存率。Mann-WitneyU,皮尔森的卡方，多元回归，进行了Kaplan-Meier和Cox比例风险分析，以评估基于熟练程度的进展培训对围手术期和生存结果的影响。
■训练案例的BMI低于非训练案例（30对32kg/m2，p=0.013），但年龄相当，绩效状况和合并症。培训对术中和术后并发症没有影响，输血,再入院<30天，回到剧院率和5年无病生存率和疾病特异性生存率中位数。在训练情况下，手术时间更长(161对137分钟，p=<0.001)。在训练情况下，估计的失血范围较小。转化率,重症监护病房入院率和淋巴水肿率具有可比性.
■基于技能的进展培训可以安全地用于指导患有子宫内膜癌的女性的机器人辅助腹腔镜手术。需要进行前瞻性研究，以进一步研究受训者进行的机器人辅助腹腔镜手术的不同部分对子宫内膜癌结局的影响。
