Proficiency of Robotic Lobectomy Based on Prior Surgical Technique in the STS General Thoracic Database.

Publication Title

The Annals of thoracic surgery

Authors

Andrew F Feczko, Department of Thoracic Surgery, Swedish Medical Center, Seattle, WAFollow
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, WashingtonFollow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Eric Vallières, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Brian E Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow

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

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.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery