Defining benchmarks for robotic-assisted low anterior rectum resection in low-morbid patients: a multicenter analysis

Egberts, Jan‐Hendrik; Kersebaum, Jan-Niclas; Mann, B.; Aselmann, H.; Hirschburger, Markus; Grass, Julia; Becker, Thomas; Izbicki, Jakob R.; Perez, Daniel

doi:10.1007/s00384-021-03988-6

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…Recent international benchmarks for robotic surgery for low anterior resection provides a framework of key clinical standards, including cut off values for conversion of < 4.0%, intra-operative complication rates of < 1.4% and < 28% for all post-operative complications (17). Our clinical outcomes fall within the remit of these international benchmarking criteria, despite all operations being performed by trainees.…”

Section: Discussionmentioning

confidence: 99%

Parallel, component training in robotic total mesorectal excision

et al. 2022

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BackgroundThere has been widespread adoption of robotic total mesorectal excision (TME) for rectal cancer in recent years. There is now increasing interest in training robotic novice surgeons in robotic TME surgery using the principles of component-based learning. The aims of our study were to assess the feasibility of delivering a structured, parallel, component-based, training curriculum to surgical trainees and fellows. MethodsA prospective pilot study was undertaken between January 2021 and May 2021. A dedicated robotic training pathway was designed with two trainees trained in parallel per each robotic case based on prior experience, training grade and skill set. Component parts of each operation were allocated by the robotic trainer prior to the start of each case. Robotic pro ciency was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and the EARCS Global Assessment Score (GAS). ResultsThree trainees participated in this pilot study; performing a combined number of 52 TME resections. Key components of all 52 TME operations were performed by the trainees. GEARS scores improved throughout the study, with a mean overall baseline score of 17.3 (95% CI 15.1 -1.4) compared to an overall nal assessment mean score of 23.8 (95% CI 21.6 -25.9), p=0.003. The GAS component improved incrementally for all trainees at each candidate assessment (p<0.001). ConclusionEmploying a parallel, component-based approach to training in robotic TME surgery is safe and feasible and can be used to train multiple trainees of differing grades simultaneously, whilst maintaining high quality clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Parallel, component training in robotic total mesorectal excision

et al. 2022

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“…The present study describes beneficial effects of the total robotic approach on postoperative bowel recovery and general patient outcome during the learning curve of robotic RC with CME. Since implementation of the robotic surgery program, the institution had been evolved to a nation-wide benchmark center for robotic colorectal surgery [ 36 ]. However, we came from conventional open surgery as the generally accepted standard procedure and went directly to robotic surgery for oncologic RC without taking the detour via conventional laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…We herein report the experiences with oncologic RC including CME from a nation-wide benchmark center for robotic colorectal surgery [ 36 ] with regard to postoperative bowel recovery and patient outcome. Before implementation of the robotic program at that institution, RC was approached by COS. During the learning curve of robotic surgery, the complex procedure of oncologic RC with CME was initially performed by a robotic-assisted approach with extracorporal ileo-colic anastomosis and was finally converted to total minimally invasive robotic surgery with intracorporal anastomosis, giving the opportunity to compare both minimally invasive approaches with standard COS in the era of robotic surgery.…”

Section: Introductionmentioning

confidence: 99%

Right colectomy from open to robotic — a single-center experience with functional outcomes in a learning-curve setting

Hirschburger

Schneider

Kraenzlein

et al. 2022

Langenbecks Arch Surg

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Purpose Right colectomy (RC) is a frequently performed procedure. Beneath standard conventional open surgery (COS), various minimally invasive techniques had been introduced. Several advantages had recently been described for robotic approaches over COS or conventional laparoscopy. Nevertheless, novel minimally invasive techniques require continuous benchmarking against standard COS to gain maximum patient safety. Bowel dysfunction is a frequent problem after RC. Together with general complication rates postoperative bowel recovery are used as surrogate parameters for postoperative patient outcome in this study. Methods Retrospective, 10-year single-center analysis of consecutive patients who underwent sequentially either COS (n = 22), robotic-assisted (ECA: n = 39), or total robotic surgery (ICA: n = 56) for oncologic RC was performed. Results The conversion from robotic to open surgery rate was low (overall: 3.2%). Slightly longer duration of surgery had been observed during the early phase after introduction of the robotic program to RC (ECA versus COS, p = 0.044), but not anymore thereafter (versus ICA). No differences were observed in oncologic parameters including rates of tumor-negative margins, lymph node-positive patients, and lymph node yield during mesocolic excision. Both robotic approaches are beneficial regarding postoperative complication rates, especially wound infections, and shorter length of in-hospital stay compared with COS. The duration until first postoperative stool is the shortest after ICA (COS: 4 [2–8] days, ECA: 3 [1–6] days, ICA: 3 [1–5] days, p = 0.0004). Regression analyses reveal neither a longer duration of surgery nor the extent of mesocolic excision, but the degree of minimally invasiveness and postoperative systemic inflammation contribute to postoperative bowel dysfunction, which prolongs postoperative in-hospital stay significantly. Conclusion The current study reflects the institutional learning curve of oncologic RC during implementation of robotic surgery from robotic-assisted to total robotic approach without compromises in oncologic results and patient safety. However, the total robotic approach is beneficial regarding postoperative bowel recovery and general patient outcome.

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“…Outcome comparisons in surgery also include other clinically relevant outcome parameters such as readmission, length of stay, and comprehensive complication index (CCI) 12 13 14 . Currently, benchmarking targeting clinically relevant outcome measures for complex surgical procedures has become the focus in surgery 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 .…”

Section: Introductionmentioning

confidence: 99%

Benchmarking: a novel measuring tool for outcome comparisons in surgery

Yuan

et al. 2023

International Journal of Surgery

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Introduction: Benchmarking, a novel measuring tool for outcome comparisons, is a recent concept in surgery. The objectives of this review are to examine the concept, definition, and evolution of benchmarking and its application in surgery. Methods: The literature about benchmarking was reviewed through an ever-narrowing search strategy, commencing from the concept, definition, and evolution of benchmarking to the application of benchmarking and experiences of benchmarking in surgery. PubMed, Web of Science, Embase, and Science Direct databases were searched until 20 September 2022, in the English language according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Results: In the first phase of the literature search, the development of benchmarking was identified. The definitions of benchmarking evolved from a surveying term to a novel quality-improvement tool to assess the best achievable results in surgery. In the second phase, a total of 23 studies were identified about benchmarking in surgery, including esophagectomy, hepatic surgery, pancreatic surgery, rectum resection, and bariatric surgery. All studies were multicenter analyses from national, international, or global expert centers. Most studies (87.0%) adopted the definition that benchmark was the 75th percentile of the median values of centers. Performance metrics to define benchmarks were clinically relevant intraoperative and postoperative outcome indicators. Conclusion: Benchmarking in surgery is a novel quality-improvement tool to define and measure the best achievable results, establishing a meaningful reference to evaluate surgical performance.

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Defining benchmarks for robotic-assisted low anterior rectum resection in low-morbid patients: a multicenter analysis

Cited by 6 publications

References 11 publications

Parallel, component training in robotic total mesorectal excision

Parallel, component training in robotic total mesorectal excision

Right colectomy from open to robotic — a single-center experience with functional outcomes in a learning-curve setting

Benchmarking: a novel measuring tool for outcome comparisons in surgery

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