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Article
Proficiency of Robotic Lobectomy Based on Prior Surgical Technique in the STS General Thoracic Database.
The Annals of thoracic surgery
  • Andrew F Feczko, Department of Thoracic Surgery, Swedish Medical Center, Seattle, WA
  • Hongwei Wang
  • Katherine Nishimura, Division of Thoracic Surgery, Swedish Cancer Institute, Seattle WA, USA
  • Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington
  • Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.
  • Eric Vallières, Division of Thoracic Surgery, Swedish Cancer Institute
  • Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington
  • Brian E Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington
Document Type
Article
Publication Date
6-5-2019
Keywords
  • Aged,
  • Carcinoma, Non-Small-Cell Lung/surgery,
  • Clinical Competence,
  • Databases, Factual,
  • Female Humans,
  • Lung Neoplasms/surgery,
  • Male,
  • Operative Time,
  • Pneumonectomy/methods,
  • Retrospective Studies,
  • Robotic Surgical Procedures/methods,
  • Societies, Medical/statistics & numerical data,
  • Thoracic Surgery/statistics & numerical data,
  • Thoracic Surgery, Video-Assisted/methods,
  • United States
Disciplines
Abstract

BACKGROUND: Robotic lobectomy represents a paradigm shift for many surgeons. It is unknown if a surgeon's prior operative approach influences development of proficiency. We compared outcomes based on prior lobectomy experience and used cumulative sum (CUSUM) analysis to assess proficiency.

METHODS: Using the STS General Thoracic Database, we grouped surgeons as De novo, open- to-robotic or VATS-to-robotic. Operative time, blood transfusion, mortality and major morbidity were primary outcomes. Un/Acceptable thresholds were determined by review of the literature. Proficiency was defined as 20 consecutive cases without crossing an upper control line. Surgeons were assessed individually, and proficiency assessed by transition group.

RESULTS: From 2009-2016, 271 surgeons performed 5619 robotic lobectomies for clinical stage I/II non-small cell lung cancer. Of these, 65(24%) performed ≥20 lobectomies (4483 cases). Initial proficiency for an operative time target of 250 minutes was 40% for de novo compared to 14% of open-to-robotic and 21% of VATS-to-robotic surgeons, with improvement to 47%, 29% and 21% after 20 cases respectively. Initial and sustained proficiency related to major morbidity was similar for open-to-robotic and VATS-to-robotic, but lower for de novo at 40%. After 20 cases, most were proficient (de novo-93%, open-to-robotic-100% and VATS-to-robotic-86%). Proficiency for 30-day mortality and blood transfusion was high in all groups.

CONCLUSIONS: Outcomes among all transition groups improved with experience. OR duration proficiency was challenging for all groups. CUSUM may be useful to monitor proficiency in not only subsequent studies but in clinical practice.

Clinical Institute
Cancer
Specialty
Oncology
Specialty
Surgery
Citation Information
Andrew F Feczko, Hongwei Wang, Katherine Nishimura, Alexander S Farivar, et al.. "Proficiency of Robotic Lobectomy Based on Prior Surgical Technique in the STS General Thoracic Database." The Annals of thoracic surgery (2019)
Available at: http://works.bepress.com/brian-louie/229/