Melissa E Hogg1, Marc G Besselink2, Pierre-Alain Clavien3, Abe Fingerhut4, D Rohan Jeyarajah5, David A Kooby6, A James Moser7, Henry A Pitt8, Oliver A Varban9, Charles M Vollmer10, Herbert J Zeh11, Paul Hansen12. 1. University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA. Electronic address: hoggme@upmc.edu. 2. Academic Medical Center, Amsterdam, The Netherlands. 3. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland. 4. University Hospital of Graz, Graz, Austria. 5. Methodist Health System, Dallas, TX, USA. 6. Emory University, Department of Surgery, Atlanta, GA, USA. 7. Beth Israel Deaconess Medical Center, Pancreas and Liver Institute, Boston, MA, USA. 8. Lewis Katz School of Medicine at Temple University, Department of Surgery, Philadelphia, PA, USA. 9. University of Michigan, Division of Minimally Invasive Surgery, Ann Arbor, MI, USA. 10. University of Pennsylvania, Philadelphia, PA, USA. 11. University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA. 12. Portland Providence Cancer Institute, Liver and Pancreas Surgery, Portland, OR, USA.
Abstract
BACKGROUND: Increased incorporation of minimally invasive pancreatic resections (MIPR) has emerged into hepato-pancreato-biliary practice, however, no standardization exists for its safe adoption. Novel strategies are presented for dissemination of safe MIPR. METHODS: An international State-of-the-Art conference evaluating multiple aspects of MIPR was conducted by a panel of pancreas experts in Sao Paulo, Brazil on April 20, 2016. Training and education issues were discussed regarding the introduction of novel strategies for safe dissemination of MIPR. RESULTS: The low volume of pancreatic resections per institution poses a challenge for surgeons to overcome their MIPR learning curve without deliberate training. A mastery-based simulation and biotissue curriculum can improve technical proficiency and allow for training of surgeons before the operating room. Video-based platforms allow for performance reporting and feedback necessary for coaching and surgical quality improvement. Centers of excellence with training involving a standardized approach and proctorship are important concepts that can be utilized in various formats internationally. DISCUSSION: Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions. Published by Elsevier Ltd.
BACKGROUND: Increased incorporation of minimally invasive pancreatic resections (MIPR) has emerged into hepato-pancreato-biliary practice, however, no standardization exists for its safe adoption. Novel strategies are presented for dissemination of safe MIPR. METHODS: An international State-of-the-Art conference evaluating multiple aspects of MIPR was conducted by a panel of pancreas experts in Sao Paulo, Brazil on April 20, 2016. Training and education issues were discussed regarding the introduction of novel strategies for safe dissemination of MIPR. RESULTS: The low volume of pancreatic resections per institution poses a challenge for surgeons to overcome their MIPR learning curve without deliberate training. A mastery-based simulation and biotissue curriculum can improve technical proficiency and allow for training of surgeons before the operating room. Video-based platforms allow for performance reporting and feedback necessary for coaching and surgical quality improvement. Centers of excellence with training involving a standardized approach and proctorship are important concepts that can be utilized in various formats internationally. DISCUSSION: Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions. Published by Elsevier Ltd.
Authors: Richard S Hoehn; Ibrahim Nassour; Mohamed A Adam; Sharon Winters; Alessandro Paniccia; Amer H Zureikat Journal: J Gastrointest Surg Date: 2020-04-20 Impact factor: 3.452
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