Maurice J W Zwart, Bram L J van den Broek, Diederik S J Paijens, Sabrina L M Zwetsloot, Annalisa Comandatore, Olivier R Busch, T C Khé Tran, Misha D Luyer, Jennifer Schreinemakers, Jan H Wijsman, George P van der Schelling, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Kosei Takagi, Roeland F de Wilde, Luca Morelli, Herbert J Zeh, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, Marc G Besselink
{"title":"胰十二指肠切除术中机器人胃肠造口手术表现的视频评估：评估学习曲线和胃排空延迟的风险。","authors":"Maurice J W Zwart, Bram L J van den Broek, Diederik S J Paijens, Sabrina L M Zwetsloot, Annalisa Comandatore, Olivier R Busch, T C Khé Tran, Misha D Luyer, Jennifer Schreinemakers, Jan H Wijsman, George P van der Schelling, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Kosei Takagi, Roeland F de Wilde, Luca Morelli, Herbert J Zeh, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, Marc G Besselink","doi":"10.1097/SLA.0000000000006692","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to identify learning curves for robotic gastro-enterostomy (RGE) during RPD and the predictive value of the objective structured assessment of technical skills (OSATS) score for DGE according to the Birkmeyer et al and UPMC method.</p><p><strong>Summary of background data: </strong>In some series, robotic pancreatoduodenectomy (RPD) has been associated with increased risk of delayed gastric emptying (DGE). It is unclear whether this is attributable to learning curve. Improved surgical performance and experience has not yet been linked to a decrease in delayed gastric emptying in RPD.</p><p><strong>Methods: </strong>Post-hoc study of the prospective multicenter (LAELAPS-3) training program including videos of RGE during RPD. Surgical performance was scored with OSATS by two blinded graders. The main outcomes are the combined OSATS scores of two blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and clinically relevant DGE (grade B/C).</p><p><strong>Results: </strong>Videos from 192 RGE anastomoses were included. DGE occurred in 42/192 (21.9%) patients. Mean OSATS score was 22.4 (SD±5.1) and predicted DGE (AUC 0.668, P<0.001). The predictive OSATS elements for DGE were gentleness (AUC 0.719, P<0.001), instrument handling (AUC 0.595 P=0.043), tissue exposure (AUC 0.625, P=0.009), and summary score (AUC 0.665, P<0.001). An OSATS score >25 was associated with a 59.9% reduced relative risk of grade B/C DGE (11.3% (8/71) vs 28.1% (34/121); OR 0.325, P=0.006). CUSUM analysis of RGE-OSATS identified a turning point at 34 procedures (27.5% (36/140) before vs 11.5% (6/52) after; OR 0.156, P=0.035. On multivariable analysis for grade B/C DGE, OSATS ≤25 remained an independent risk factor (OR 2.907, P=0.028).</p><p><strong>Conclusions: </strong>Better surgical performance during gastro-enteric anastomosis in RPD, as assessed by OSATS, is associated with a reduced rate of grade B/C DGE. OSATS could serve as a tool for competency-based training programs and quality-controlled implementation of RPD.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Video-assessment of Surgical Performance in Robotic Gastro-enterostomy During Pancreatoduodenectomy: Evaluating the Learning Curve and Risk of Delayed Gastric Emptying.\",\"authors\":\"Maurice J W Zwart, Bram L J van den Broek, Diederik S J Paijens, Sabrina L M Zwetsloot, Annalisa Comandatore, Olivier R Busch, T C Khé Tran, Misha D Luyer, Jennifer Schreinemakers, Jan H Wijsman, George P van der Schelling, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Kosei Takagi, Roeland F de Wilde, Luca Morelli, Herbert J Zeh, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, Marc G Besselink\",\"doi\":\"10.1097/SLA.0000000000006692\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The aim of this study is to identify learning curves for robotic gastro-enterostomy (RGE) during RPD and the predictive value of the objective structured assessment of technical skills (OSATS) score for DGE according to the Birkmeyer et al and UPMC method.</p><p><strong>Summary of background data: </strong>In some series, robotic pancreatoduodenectomy (RPD) has been associated with increased risk of delayed gastric emptying (DGE). It is unclear whether this is attributable to learning curve. Improved surgical performance and experience has not yet been linked to a decrease in delayed gastric emptying in RPD.</p><p><strong>Methods: </strong>Post-hoc study of the prospective multicenter (LAELAPS-3) training program including videos of RGE during RPD. Surgical performance was scored with OSATS by two blinded graders. The main outcomes are the combined OSATS scores of two blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and clinically relevant DGE (grade B/C).</p><p><strong>Results: </strong>Videos from 192 RGE anastomoses were included. DGE occurred in 42/192 (21.9%) patients. Mean OSATS score was 22.4 (SD±5.1) and predicted DGE (AUC 0.668, P<0.001). The predictive OSATS elements for DGE were gentleness (AUC 0.719, P<0.001), instrument handling (AUC 0.595 P=0.043), tissue exposure (AUC 0.625, P=0.009), and summary score (AUC 0.665, P<0.001). An OSATS score >25 was associated with a 59.9% reduced relative risk of grade B/C DGE (11.3% (8/71) vs 28.1% (34/121); OR 0.325, P=0.006). CUSUM analysis of RGE-OSATS identified a turning point at 34 procedures (27.5% (36/140) before vs 11.5% (6/52) after; OR 0.156, P=0.035. On multivariable analysis for grade B/C DGE, OSATS ≤25 remained an independent risk factor (OR 2.907, P=0.028).</p><p><strong>Conclusions: </strong>Better surgical performance during gastro-enteric anastomosis in RPD, as assessed by OSATS, is associated with a reduced rate of grade B/C DGE. OSATS could serve as a tool for competency-based training programs and quality-controlled implementation of RPD.</p>\",\"PeriodicalId\":8017,\"journal\":{\"name\":\"Annals of surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2025-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLA.0000000000006692\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006692","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Video-assessment of Surgical Performance in Robotic Gastro-enterostomy During Pancreatoduodenectomy: Evaluating the Learning Curve and Risk of Delayed Gastric Emptying.
Objective: The aim of this study is to identify learning curves for robotic gastro-enterostomy (RGE) during RPD and the predictive value of the objective structured assessment of technical skills (OSATS) score for DGE according to the Birkmeyer et al and UPMC method.
Summary of background data: In some series, robotic pancreatoduodenectomy (RPD) has been associated with increased risk of delayed gastric emptying (DGE). It is unclear whether this is attributable to learning curve. Improved surgical performance and experience has not yet been linked to a decrease in delayed gastric emptying in RPD.
Methods: Post-hoc study of the prospective multicenter (LAELAPS-3) training program including videos of RGE during RPD. Surgical performance was scored with OSATS by two blinded graders. The main outcomes are the combined OSATS scores of two blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and clinically relevant DGE (grade B/C).
Results: Videos from 192 RGE anastomoses were included. DGE occurred in 42/192 (21.9%) patients. Mean OSATS score was 22.4 (SD±5.1) and predicted DGE (AUC 0.668, P<0.001). The predictive OSATS elements for DGE were gentleness (AUC 0.719, P<0.001), instrument handling (AUC 0.595 P=0.043), tissue exposure (AUC 0.625, P=0.009), and summary score (AUC 0.665, P<0.001). An OSATS score >25 was associated with a 59.9% reduced relative risk of grade B/C DGE (11.3% (8/71) vs 28.1% (34/121); OR 0.325, P=0.006). CUSUM analysis of RGE-OSATS identified a turning point at 34 procedures (27.5% (36/140) before vs 11.5% (6/52) after; OR 0.156, P=0.035. On multivariable analysis for grade B/C DGE, OSATS ≤25 remained an independent risk factor (OR 2.907, P=0.028).
Conclusions: Better surgical performance during gastro-enteric anastomosis in RPD, as assessed by OSATS, is associated with a reduced rate of grade B/C DGE. OSATS could serve as a tool for competency-based training programs and quality-controlled implementation of RPD.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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