Intraoperative Resident Education for Robotic Laparoscopic Gastric Banding Surgery: A Pilot Study on the Safety of Stepwise Education

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• 作者：Daniel A. Hashimoto ; BA^a ; Ernest D. Gomez ; BSE^a ; Enrico Danzer ; MD^b ; Paula K. Edelson ; BSc^a ; Jon B. Morris ; MD ; FACS^b ; Noel N. Williams ; MBBCh ; FRCSI^b ; Kristoffel R. Dumon ; MD ; FACS^b ; ^{kristoffel.dumon@uphs.upenn.edu}
• 关键词：CTM ; classical training model ; CY4 ; clinical year 4 ; dVSS ; Da Vinci Surgical System ; PTM ; proctored training model ; R-LAGB ; robotic laparoscopic-assisted gastric banding
• 刊名：Journal of the American College of Surgeons
• 出版年：2012
• 期刊代码：175_10727515
• 类别：med
• 出版时间：June, 2012
• 卷：214
• 期：6
• 页码：990-996
• 文件大小：1160 K

摘要

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Background

Incorporation of robotic surgery into resident education poses questions regarding intraoperative teaching and patient care. This study aimed to evaluate the impact of gradually increasing resident console responsibility on resident competency and patient safety, in the presence of a proctor and bedside surgeon, for robotic laparoscopic-assisted gastric banding (R-LAGB) compared with the classical training model (CTM) of residents as first assistant.

Study Design

Eight clinical year 4 (CY4) residents completed 60 R-LAGB using a one-to-one proctored training model (PTM). R-LAGB was distilled into 7 key steps: gastroesophageal-junction dissection, gastrohepatic ligament dissection, retrogastric space creation, band placement, band closure, gastrogastric suturing, and port placement. Residents performed more complex steps after each case to gain competency in all aspects of the operation. Patient demographics, comorbidities, operative complications, operating times, and clinical outcomes were compared with a control group of 287 R-LAGB cases completed using the CTM (n = 15 CY4 residents).

Results

All residents using the PTM were able to successfully complete an R-LAGB as primary surgeon after a median of 8 operations (range 5 to 11); no residents in the CTM completed an R-LAGB as primary surgeon. Mean operative time was statistically greater in the PTM group (99.3 卤 22.1 minutes) vs CTM (91.5 卤 21.1 minutes) (p = 0.001). There were no intraoperative complications in either group; incidence of postoperative complications was similar between groups.

Conclusions

All residents in the proctored setting claimed competence and have persistent console experience without significantly increasing procedure complications. PTM, otherwise known as stepwise education, is a safe, standardized method to train surgical residents in R-LAGB.