Biotissue Curriculum Translates to Performance in the Operating Room for Gastrojejunostomy and Hepaticojejunostomy in Robotic Pancreaticoduodenectomy

Abstract

Objective: Robotic simulation training curricula aim to aid surgeons in attaining robotic operating room proficiency, but the crossover success remains to be examined.

Design: A retrospective cohort study grading robotic biotissue training models and intraoperative anastomotic videos. The curriculum included deliberate practice of inanimate drills of a hepaticojejunostomy (HJ) and gastrojejunostomy (GJ). Videos were blindly reviewed, and performance was evaluated by time, errors, and Objective Structured Assessment of Technical Skills (OSATS). Spearman's correlation coefficients (ρ) were calculated for prior experience, biotissue performance, and intraoperative performance.

Setting: University of Pittsburgh Medical Center from 2014 to 2018.

Participants: Thirty-one surgical oncology fellows participated in the 5-step proficiency-based robotic training curriculum for robotic pancreaticoduodenectomy.

Results: Fellows completed an average of 5.1 ± 3.7 HJ and 4.3 ± 3.3 GJ on biotissue. More practice on biotissue correlated with greater improvement on both times to complete an anastomosis (ρ = -0.51) and errors (ρ = -0.45). Average errors on biotissue GJ and longer time on the last attempt correlated with lower average intraoperative GJ OSATS (ρ = -0.64; ρ = -0.66). More errors on the last biotissue GJ correlated with longer average intraoperative GJ time (ρ = 0.58). Errors on the first and average biotissue HJ errors correlated with lower OSATS for the intraoperative HJ (ρ = -0.74; ρ = -0.80).

Conclusions: Performance on biotissue correlated with intraoperative performance. Results suggest the importance deliberate practice to achieve surgical proficiency.

Keywords: operative performance; robotic pancreaticoduodenectomy; robotic training; surgical training; technical performance.