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Teaching robotic rectal cancer surgery at your workplace: does the presence of visiting surgeons in the operating room have a detrimental effect on outcomes?

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Abstract

Background

Surgery demonstration (SD) is considered to be a mainstay of surgical education, but controversy exists concerning the patient’s safety. Indeed, the presence of visiting surgeons is a source of distraction and may have an impact on surgeon’s performance. This study’s objective was to evaluate possible differences in outcomes between robotic sphincter-saving rectal cancer surgery (RRCS) performed during routine surgical practice versus in the presence of visiting surgeons in the operating room (OR) with direct access to the surgeon.

Methods

Retrospective case-matched studies were conducted from a prospectively collected database. 114 patients (38 with the presence of visiting surgeons) who underwent RRCS between January 2013 and September 2018 were included. Patients were matched in a 1:2 basis after propensity score analysis using five criteria: gender, body mass index, preoperative chemoradiation, type of mesorectum excision, and synchronous liver metastasis.

Results

There was no difference between the two groups with regard to mean operating time, estimated blood loss, conversion, and hospital stay. Also, overall (44% vs. 40%; P = 0.6), major morbidity (26% vs. 19%; P = 0.5), and unplanned reoperation (17% vs. 15%; P = 1.0) rates were not statistically different. No difference was noted with regard to the quality of mesorectum excision, or positive rate of circumferential and distal longitudinal resection margins. The mean number of harvested lymph nodes (17 vs. 14.5; P = 0.04) was lower in the SD group and the number of patients with < 12 harvested lymph nodes (31% vs. 16%; P = 0.09) was greater after SD although it did not reach statistical significance. No differences were observed in disease-free or overall survival.

Conclusions

The presence of visiting surgeons in the OR seems not to interfere in the quality of rectal resection and does not compromise patient’s short-term outcome and survival. However, mild differences in the extent of lymphadenectomy were observed and the surgeons performing SD may be aware of this.

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Notes

  1. The Groupe Hospitalier Diaconesses Croix Saint Simon is an institutional no-profit tertiary center from Paris, France.

Abbreviations

SD:

Surgery demonstration

RRCS:

Robotic sphincter-saving rectal cancer surgery

RALS:

Robotic-assisted laparoscopic surgery

GHDCSS:

Groupe Hospitalier Diaconesses Croix Saint Simon

BMI:

Body mass index

ME:

Mesorectum excision

ASA:

American Society of Anesthesiologists

EBL:

Estimated blood loss

LoS:

Length of stay

HLN:

Harvested lymph nodes

MIS:

Minimally invasive surgery

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Groupe Hospitalier Diaconesses – Croix Saint-Simon, Service de Chirurgie Digestive, 125, rue d’Avron, 75020, Paris, France

    Alain Valverde, Nicolas Goasguen, Olivier Oberlin, Auriana Tetart, Julien Cahais & Renato M. Lupinacci

  2. Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris, France

    Kevin Zuber

  3. Sorbonne Université, Université Pierre et Marie Curie – Paris 6, Paris, France

    Jean-François Fléjou

  4. Service d’Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, 184, rue du Faubourg Saint Antoine, 75012, Paris, France

    Jean-François Fléjou

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  1. Alain Valverde
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  3. Nicolas Goasguen
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  4. Olivier Oberlin
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Correspondence to Alain Valverde.

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Disclosures

Drs. Nicolas Goasguen, Olivier Oberlin and Alain Valverde are proctors for Intuitive Surgery, Inc. Mr Kevin Zuber, and Drs. Auriana Tetart, Jean-François Fléjou, Julien Cahais, and Renato Micelli Lupinacci have no conflicts of interest or financial ties to disclose.

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Valverde, A., Zuber, K., Goasguen, N. et al. Teaching robotic rectal cancer surgery at your workplace: does the presence of visiting surgeons in the operating room have a detrimental effect on outcomes?. Surg Endosc 34, 3936–3943 (2020). https://doi.org/10.1007/s00464-019-07164-4

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