Zentralbl Chir 2021; 146(S 01): S79
DOI: 10.1055/s-0041-1733440
Abstracts

V-209 Proctor-Based Implementation Of A RATS-Program - Propensity-Matched Feasibility And Oncological Results

PV Stropnicky
1   Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Kiel, Deutschland
,
T Möller
1   Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Kiel, Deutschland
,
T Becker
1   Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Kiel, Deutschland
,
M Steinert
2   Universitätsklinikum Leipzig, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie - Sektion Thoraxchirurgie, Leipzig, Deutschland
,
H Winter
3   Universitätsklinikum Heidelberg, Abteilung für Thoraxchirurgie, Thoraxklinik, Heidelberg, Deutschland
,
M Eichhorn
3   Universitätsklinikum Heidelberg, Abteilung für Thoraxchirurgie, Thoraxklinik, Heidelberg, Deutschland
,
J-H Egberts
1   Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Kiel, Deutschland
4   Israelitisches Krankenhaus Hamburg, Chirurgische Klinik, Hamburg, Deutschland
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Hintergrund

Robotic-assisted thoracic surgery (RATS) offers same benefits as video-assisted thoracic surgery (VATS) with additional advantages like angled instruments, better visualization and tremor filtration. In Germany, the development of RATS is still in its beginnings. In recent years, RATS implementation has been facilitated by proctoring and this is intended to lead to a faster and safe introduction with shortening of the learning curve. To evaluate proctor-based implementation, we compared RATS implementation with and without proctoring in three German Centers.


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Material und Methode

We compared proctor-based implementation in a Junior Center (J) to non-proctor-based implementation in two Senior Centers (S). In a first analysis, each initial 20 cases of S were compared to the initial 20 cases of J (S1 vs. J). To evaluate whether J can already achieve in its learning curve comparable results to S after completion of their learning curve, J´s initial cases were matched with 20 cases of S in a second analysis (S2 vs J). Matching criteria were age, BMI, neoadjuvant therapy, ASA, COPD and pT stages. Operation times, conversion rates, lymphadenectomy based on the number of removed lymph nodes and upstaging rates, duration of stay and drainage, reoperation and complication rates were analyzed.


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Ergebnis

225 RATS resections were performed in the study period in all centers. In both analyses (S1 vs. J / S2 vs. J), operation times of J were longer (169 vs. 212min/ 172 vs. 212min). Number of conversions of J were comparable to S1 (4 vs. 4) and higher to S2 (0 vs. 4). J showed a higher number of removed lymph nodes (13 vs. 19/18 vs. 19), which was significant in S1 vs. J (p=0,014). There was no difference in upstaging rates (p=0,562/ p=0,834).

In both analyses the reoperation rates, length of drainage and stay were similar. Only one patient in J was affected by a complication, while 57.5% in S1 and 50% in S2 remained without complications. The difference was significant in S2 vs J (p=0,117/ p=0,019).


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Schlussfolgerung

Our study showed that initial cases can be performed safe and in international comparison quickly with better lymph node resection and fewer complications in the setting of proctor-based implementation.


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Publication History

Article published online:
06 September 2021

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