V36: Biotissue Training Curriculum Correlates with Intraoperative Performance for Robotic Pancreaticoduodenectomy

Wednesday, March 2, 2022

5:40 PM – 5:43 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Amer H. Zureikat, MD

Associate Professor of Surgery, Chief Division of Surgical Oncology
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

Jasmine D. Kraftician, BS: Disclosure information not submitted.

Introduction: There has been a rise in the use of the robotic platform for minimally invasive pancreatic surgery. Robotic training curricula aim to aid surgeons in attaining robotic proficiency, but their success remains to be examined. We hypothesized that performance on inanimate drills correlates with intraoperative (intra-op) performance during a robotic pancreaticoduodenectomy (RPD).

Methods: Thirty-one surgical oncology fellows participated in a 5-step proficiency-based robotic training curriculum from 2014-2018. The curriculum included inanimate drills of a continuous hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) and operative experience. Video review of biotissue and intra-op performance during these anastomoses was performed. Performance was evaluated by time, errors, and Objective Structured Assessment of Technical Skills (OSATS). Spearman’s correlations were calculated for prior experience, biotissue performance, and intra-op performance.

Results: Fellows completed an average of 14.1±10.5 biotissue drills including 5.1±3.7 HJ and 4.3±3.3 GJ. Biotissue GJ and HJ showed a decrease in time and errors, and an increase in OSATS. Longer total time on biotissue GJ and HJ correlated with improvement in time (ρ=-.51) and errors (ρ=-.45). Average errors on biotissue GJ and longer time on the last attempt correlated with lower average intra-op GJ OSATS (ρ=-.64; ρ=-.66). More errors on the last biotissue GJ correlated with longer average intra-op GJ time (ρ=.58). Errors on the first and average biotissue HJ correlated with lower OSATS for the first intra-op HJ (ρ=-.737; ρ=-.80). The more days separating biotissue and the second intra-op HJ correlated with more time to complete the intra-op HJ (ρ=.92).

Conclusions: The results support correlation between inanimate and intra-op performance which may expedite surgeon proficiency. Further research is warranted to examine whether benefits translate to fewer surgical complications and improved patient outcomes.

Learning Objectives:

develop their surgical skills for robotic pancreatic surgery and demonstrate robotic proficiency.
assess and improve upon their robotic surgical technique for the continuous hepaticojejunostomy and gastrojejunostomy based on past performance.
outline the fundamentals of a robotic training curriculum and organize training programs at other institutions.