A senior surgical resident can safely perform complex esophageal cancer surgery after surgical mentoring program – Experience of a European High-Volume Center
EAES Academy. Krauss - Müller D. 07/05/22; 363162; P207
Dr. Dolores Thea Krauss - Müller
Contributions
Contributions
Abstract
Background:
Previous studies have shown that if provided adequate training, patient selection and supervision residents can safely perform a variation of complex abdominal surgeries with equivalent outcomes compared to experience board certified surgeons. We have previously published a training curriculum for robotic assisted minimally invasive esophagectomy that may lead to a reduction in time to reach proficiency. However, while graduates from general surgery programs feel confident in their skills, training especially in esophageal surgery, which presents with a high postoperative morbidity up to 60%, is lacking. We aimed to investigate if a surgical resident could safely perform complex esophageal surgery when a structured modular teaching curriculum is applied.
Methods:
Our prospectively collected, IRB approved database was searched to identify all Ivor-Lewis esophagectomies performed by the selected surgical resident from 08/2019-7/2021. Outcomes of patients where then compared to our overall cohort of open, hybrid and robotic Ivor-Lewis esophagectomies from 05/2016 – 05/2020. A structured teaching program based on our previously published modular step-up approach was applied by two experienced board-certified foregut surgeons.
Results:
A total of 567 patients were analyzed. A total of 65 patients underwent an Ivor Lewis esophagectomy performed by the selected surgical resident. A total of 502 patients in the overall cohort underwent either an open, hybrid or robotic procedure. Demographic and oncological data is shown in Table 1. Mean age was 64.6 years (range 43-82) in the resident group and 63 years (range 33-91) in the overall cohort (p=0.2433). Further details about postoperative complications are depicted in Table 2. No statistically significant difference was seen in sever postoperative complications defined as Clavien-Dindo ≥ IIIa (p= 0.2349)
Conclusion:
A structured modulacr step-up for training a surgical resident to perform complex esophageal cancer surgery can successfully maintain patient safety and outcomes.
Previous studies have shown that if provided adequate training, patient selection and supervision residents can safely perform a variation of complex abdominal surgeries with equivalent outcomes compared to experience board certified surgeons. We have previously published a training curriculum for robotic assisted minimally invasive esophagectomy that may lead to a reduction in time to reach proficiency. However, while graduates from general surgery programs feel confident in their skills, training especially in esophageal surgery, which presents with a high postoperative morbidity up to 60%, is lacking. We aimed to investigate if a surgical resident could safely perform complex esophageal surgery when a structured modular teaching curriculum is applied.
Methods:
Our prospectively collected, IRB approved database was searched to identify all Ivor-Lewis esophagectomies performed by the selected surgical resident from 08/2019-7/2021. Outcomes of patients where then compared to our overall cohort of open, hybrid and robotic Ivor-Lewis esophagectomies from 05/2016 – 05/2020. A structured teaching program based on our previously published modular step-up approach was applied by two experienced board-certified foregut surgeons.
Results:
A total of 567 patients were analyzed. A total of 65 patients underwent an Ivor Lewis esophagectomy performed by the selected surgical resident. A total of 502 patients in the overall cohort underwent either an open, hybrid or robotic procedure. Demographic and oncological data is shown in Table 1. Mean age was 64.6 years (range 43-82) in the resident group and 63 years (range 33-91) in the overall cohort (p=0.2433). Further details about postoperative complications are depicted in Table 2. No statistically significant difference was seen in sever postoperative complications defined as Clavien-Dindo ≥ IIIa (p= 0.2349)
Conclusion:
A structured modulacr step-up for training a surgical resident to perform complex esophageal cancer surgery can successfully maintain patient safety and outcomes.
Background:
Previous studies have shown that if provided adequate training, patient selection and supervision residents can safely perform a variation of complex abdominal surgeries with equivalent outcomes compared to experience board certified surgeons. We have previously published a training curriculum for robotic assisted minimally invasive esophagectomy that may lead to a reduction in time to reach proficiency. However, while graduates from general surgery programs feel confident in their skills, training especially in esophageal surgery, which presents with a high postoperative morbidity up to 60%, is lacking. We aimed to investigate if a surgical resident could safely perform complex esophageal surgery when a structured modular teaching curriculum is applied.
Methods:
Our prospectively collected, IRB approved database was searched to identify all Ivor-Lewis esophagectomies performed by the selected surgical resident from 08/2019-7/2021. Outcomes of patients where then compared to our overall cohort of open, hybrid and robotic Ivor-Lewis esophagectomies from 05/2016 – 05/2020. A structured teaching program based on our previously published modular step-up approach was applied by two experienced board-certified foregut surgeons.
Results:
A total of 567 patients were analyzed. A total of 65 patients underwent an Ivor Lewis esophagectomy performed by the selected surgical resident. A total of 502 patients in the overall cohort underwent either an open, hybrid or robotic procedure. Demographic and oncological data is shown in Table 1. Mean age was 64.6 years (range 43-82) in the resident group and 63 years (range 33-91) in the overall cohort (p=0.2433). Further details about postoperative complications are depicted in Table 2. No statistically significant difference was seen in sever postoperative complications defined as Clavien-Dindo ≥ IIIa (p= 0.2349)
Conclusion:
A structured modulacr step-up for training a surgical resident to perform complex esophageal cancer surgery can successfully maintain patient safety and outcomes.
Previous studies have shown that if provided adequate training, patient selection and supervision residents can safely perform a variation of complex abdominal surgeries with equivalent outcomes compared to experience board certified surgeons. We have previously published a training curriculum for robotic assisted minimally invasive esophagectomy that may lead to a reduction in time to reach proficiency. However, while graduates from general surgery programs feel confident in their skills, training especially in esophageal surgery, which presents with a high postoperative morbidity up to 60%, is lacking. We aimed to investigate if a surgical resident could safely perform complex esophageal surgery when a structured modular teaching curriculum is applied.
Methods:
Our prospectively collected, IRB approved database was searched to identify all Ivor-Lewis esophagectomies performed by the selected surgical resident from 08/2019-7/2021. Outcomes of patients where then compared to our overall cohort of open, hybrid and robotic Ivor-Lewis esophagectomies from 05/2016 – 05/2020. A structured teaching program based on our previously published modular step-up approach was applied by two experienced board-certified foregut surgeons.
Results:
A total of 567 patients were analyzed. A total of 65 patients underwent an Ivor Lewis esophagectomy performed by the selected surgical resident. A total of 502 patients in the overall cohort underwent either an open, hybrid or robotic procedure. Demographic and oncological data is shown in Table 1. Mean age was 64.6 years (range 43-82) in the resident group and 63 years (range 33-91) in the overall cohort (p=0.2433). Further details about postoperative complications are depicted in Table 2. No statistically significant difference was seen in sever postoperative complications defined as Clavien-Dindo ≥ IIIa (p= 0.2349)
Conclusion:
A structured modulacr step-up for training a surgical resident to perform complex esophageal cancer surgery can successfully maintain patient safety and outcomes.
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