Model for Implementing a Robotic Surgical Platform in an Established Minimally Invasive Thoracic University Affiliated Community Practice.
Nicholas Baker, Ryan Levy, Ernest Chan, Inderpal Sarkaria.
UPMC, Pittsburgh, PA, USA.
Objective: Our objective is to describe a paradigm for developing a robotic thoracic surgery program in a university-affiliated, community thoracic surgery setting. The secondary objective is to present the early interim results of cases performed in the first 4 years.
Method: A robust, established community thoracic practice was designated as the site for developing our community thoracic robotic surgery practice. A senior (VATS) surgeon was paired with a junior attending surgeon with robotic experience. A senior thoracic robotic surgeon provided proctoring. Mentoring was performed through a supervised series of cases until independence was granted. Herein, we present the results of our initial experience utilizing this paradigm of program development.
Results: 88 planned robotic thoracic procedures were performed between July 1, 2015 to May 31, 2019. Volume increased annually from 4 in 2015 to 28 in 2018. Projected volume for 2019 is 48 cases. Case volume directly correlated with acquisition of operative block time. The most common procedure performed in decreasing order: lung resection, mediastinal, foregut, diagnostic. There were two conversions to thoracoscopy/laparoscopy, and one conversion to open. Two cases were aborted. Major complication rate was 10%. There were no mortalities at 30 or 90-days.
Conclusion: Pairing a senior VATS surgeon with a recent graduate under senior robotic guidance has critical advantages. This paradigm takes advantage of the robotic skills of the recent graduate and the established case volume and experience of the senior surgeon. Moreover, it maximizes safety and strong clinical outcomes, and accelerates the learning curve for both surgeons.
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