Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Jones Leia R, Zwart Maurice J W, Nickel Felix, Hackert Thilo, Daams Freek, Groot Koerkamp Bas, Molenaar Quintus, Boggi Ugo, Saint Marc Olivier, Leenart Philip, Amiri Rawin, Ali Mahsoem, Festen Sebastiaan, Busch Olivier, Krohn Paul S, Sparrelid Ernesto, Björnsson Bergthor, Toso Christian, Rosso Edoardo, Strücker Benjamin, Strandberg-Holka Peter, Dewulf Maxime, Schmeding Maximilian, Bozkurt Emre, Ferrari Giovanni, White Steve, Vigia Emanuel, Soonawalla Zahir, Stommel Martijn, Worthington Tim, Lovecek Martin, Dunne Declan, Marchegiani Giovanni, Gryspeerdt Filip, Hogg Melissa E, Abu Hilal Mohammad, Besselink Marc G, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Аннотация
SUMMARY BACKGROUND DATA: The implementation of RPD into clinical practice comes with considerable challenges, leading to concerns about patient safety, oncological outcomes, and costs. To address this, a structured training program was implemented in which 2 surgeons at each of the 20 sites were trained and maintained as a consistent operative team.
STUDY DESIGN: A structured training program for RPD was implemented, and outcomes prospectively collected in 20 European high-volume centers, all without previous RPD experience, from 12 countries. The program included a video library, biotissue simulation (pancreaticojejunostomy and hepaticojejunostomy), off-site RPD case observations, and on-site proctoring. Surgeons' simulation anastomoses were assessed using Objective Structured Assessment of Technical Skills (OSATS) and technical errors. The primary endpoint was intra- and postoperative patient outcome. A key secondary analysis assessed safety using OSATS scores and error counts, and major correlated with conversion and postoperative outcomes.
RESULTS: Overall, 486 RPD procedures were performed. Median intraoperative blood loss was 200 mL (IQR: 100-400), operative time was 475 minutes (IQR: 414-553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade ≥III complications was 31.4% (n=153), POPF was 21.2% (n=103), delayed gastric emptying was 15% (n=73), postpancreatectomy hemorrhage was 8.6% (n=42), and in-hospital/30-day mortality was 2.7% (n=13). Median length of stay was 12 days (IQR: 8-20). During simulation training, OSATS scores significantly improved (0.350 points/attempt (ρ), P<0.001) while the duration of reconstruction decreased (P<0.001). Multivariable analysis found no association between error count and major complications.
CONCLUSIONS: We report on the first successfully completed international training program for RPD. Simulation established a standardized technical competency, although a learning-curve effect (major complications) remained detectable per center. These data highlight that safe adoption of complex procedures requires structured, team-based, proctored training beyond simulation alone.