BACKGROUND: Thoracic laparoscopic robot-assisted minimally invasive esophagectomy (RAMIE) was developed in 2003. RAMIE was shown to be safe and oncologically effective. The aim of this study was to assess the learning curve and the proctoring program for a newly introduced surgeon (surgeon 2). METHODS: The "learning curve" was defined as the number of operations that must be performed by a surgeon to achieve a steady level of performance. Measures of proficiency to describe the learning curve of the proctor and the newly introduced surgeon 2 included operating time, blood loss, and conversion rates and were analyzed using the cumulative sum method. Results of the newly introduced surgeon were compared with the proctor in the same period of time. RESULTS: The proctor performed 232 of 312 procedures (74%) and surgeon 2 performed 80 of 312 procedures (26%). The proctor reached proficiency after 70 procedures in 55 months. The structured proctoring program for surgeon 2 started with 20 procedures as assisting table surgeon, followed by 5 observational and 15 supervised cases. Surgeon 2 performed at the same level as the proctor concerning operating time, blood loss, conversion rates, radicality, and complications. For surgeon 2, the learning phase of thoracic laparoscopic RAMIE was completed within 24 cases (15 supervised and 9 independent cases) in 13 months; a reduction of 66% in the number of operations and a reduction of 76% in time, compared with the proctor. CONCLUSIONS: The learning phase of thoracic laparoscopic RAMIE consisted of 70 procedures in 55 months. A structured proctoring for RAMIE substantially reduced the number of procedures and time required to achieve proficiency.
BACKGROUND: Thoracic laparoscopic robot-assisted minimally invasive esophagectomy (RAMIE) was developed in 2003. RAMIE was shown to be safe and oncologically effective. The aim of this study was to assess the learning curve and the proctoring program for a newly introduced surgeon (surgeon 2). METHODS: The "learning curve" was defined as the number of operations that must be performed by a surgeon to achieve a steady level of performance. Measures of proficiency to describe the learning curve of the proctor and the newly introduced surgeon 2 included operating time, blood loss, and conversion rates and were analyzed using the cumulative sum method. Results of the newly introduced surgeon were compared with the proctor in the same period of time. RESULTS: The proctor performed 232 of 312 procedures (74%) and surgeon 2 performed 80 of 312 procedures (26%). The proctor reached proficiency after 70 procedures in 55 months. The structured proctoring program for surgeon 2 started with 20 procedures as assisting table surgeon, followed by 5 observational and 15 supervised cases. Surgeon 2 performed at the same level as the proctor concerning operating time, blood loss, conversion rates, radicality, and complications. For surgeon 2, the learning phase of thoracic laparoscopic RAMIE was completed within 24 cases (15 supervised and 9 independent cases) in 13 months; a reduction of 66% in the number of operations and a reduction of 76% in time, compared with the proctor. CONCLUSIONS: The learning phase of thoracic laparoscopic RAMIE consisted of 70 procedures in 55 months. A structured proctoring for RAMIE substantially reduced the number of procedures and time required to achieve proficiency.
Authors: Jan-Hendrik Egberts; M Biebl; D R Perez; S T Mees; P P Grimminger; B P Müller-Stich; H Stein; H Fuchs; C J Bruns; T Hackert; H Lang; J Pratschke; J Izbicki; J Weitz; T Becker Journal: J Gastrointest Surg Date: 2019-04-01 Impact factor: 3.452
Authors: S van der Horst; C Voli; I A Polanco; R van Hillegersberg; J P Ruurda; B Park; D Molena Journal: Dis Esophagus Date: 2020-11-26 Impact factor: 3.429
Authors: Pieter Christiaan van der Sluis; Peter Philipp Grimminger; Richard van Hillegersberg; Jelle Piet-Hein Ruurda Journal: J Thorac Dis Date: 2019-09 Impact factor: 2.895
Authors: R B den Boer; C de Jongh; W T E Huijbers; T J M Jaspers; J P W Pluim; R van Hillegersberg; M Van Eijnatten; J P Ruurda Journal: Surg Endosc Date: 2022-08-04 Impact factor: 3.453
Authors: E M de Groot; G M Kuiper; A van der Veen; L Fourie; L Goense; S van der Horst; J W van den Berg; R van Hillegersberg; J P Ruurda Journal: Updates Surg Date: 2022-08-17
Authors: Sylvia van der Horst; Michiel F G de Maat; Pieter C van der Sluis; Jelle P Ruurda; Richard van Hillegersberg Journal: Ann Cardiothorac Surg Date: 2019-03
Authors: Aaron R Dezube; Suden Kucukak; Luis E De León; Kostas Kostopanagiotou; Michael T Jaklitsch; Jon O Wee Journal: Surg Endosc Date: 2021-03-03 Impact factor: 4.584