The impact of a dedicated operating room team on robotic transplant program growth and fellowship training.
fellow education
medical education
nursing education
operating room nursing
operating room team
robot assisted kidney transplant
robot assisted transplant
robotic surgery
robotic transplant
transplantation
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
02
08
2023
received:
09
06
2023
accepted:
07
08
2023
medline:
13
11
2023
pubmed:
22
8
2023
entrez:
22
8
2023
Statut:
ppublish
Résumé
Despite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America. This is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training. Four hundred and two robotic cases were performed by five transplant surgeons: 63 pre-DART and 339 post-DART. 40% of cases were transplant-related and 59.5%, HPB. There was a significant increase in case volume (2.5-10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post-DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post-DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn-around-times (TAT) (58.4 vs. 40.3 min) were lower post-DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot-related complications in either group. OR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15103Subventions
Organisme : NCI NIH HHS
ID : T32 CA009621
Pays : United States
Informations de copyright
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: a literature review. Clin Transplant. 2017;31(1):e12856.
Broering D, Sturdevant ML, Zidan A. Robotic donor hepatectomy: a major breakthrough in living donor liver transplantation. Am J Transplant. 2022;22(1):14-23.
Rogers T, Corder C. Preparation of the operating room, back table, and surgical team. Robotic Urologic Surgery. Springer; 2022:33-37.
Gallioli A, Territo A, Boissier R, et al. Learning curve in robot-assisted kidney transplantation: results from the European Robotic Urological Society Working Group. Eur Urol. 2020;78(2):239-247.
Randell R, Honey S, Alvarado N, et al. Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study. BMJ Open. 2019;9(6):e028635.
Olumba F, Vachharajani N, Scherer M, et al. Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Am J Transplant. 2023.
Garbens A, Lay AH, Steinberg RL, Gahan JC. Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy. J Robot Surg. 2021;15(4):619-626.
Davidson JT Iv, Clanahan JM, Vachharajani N, et al. A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship. Am J Surg. 2023;225(2):420-424.
Sgarbura O, Vasilescu C. The decisive role of the patient-side surgeon in robotic surgery. Surg Endosc. 2010;24(12):3149-3155.
Harmanli O, Solak S, Bayram A, Yuksel B, Jones K. Optimizing the robotic surgery team: an operations management perspective. Int Urogynecol J. 2021;32:1379-1385.
Davidson J, Strand M, Cullinan D, et al. The importance of robotic surgery training in HPB fellowship: a survey of the 2022 AHPBA fellows. HPB (Oxford). 2023;S1365-182X(23):00558-0.
Davidson JT Iv, Clanahan JM, Vachharajani N, et al. A novel assessment model for teaching robot-assisted living donor nephrectomy in abdominal transplant surgery fellowship. Am J Surg. 2023;225(2):420-424.
Davis C, Grandhi M, Gazivoda V, et al. Robotic pancreatoduodenectomy: trends in technique and training challenges. HPB. 2021;23:S643-S644.
Mark Knab L, Zenati MS, Khodakov A, et al. Evolution of a novel robotic training curriculum in a complex general surgical oncology fellowship. Ann Surg Oncol. 2018;25(12):3445-3452.