Successful incorporation of robotic surgery into gynecologic oncology fellowship training.
BACKGROUND
The increasing role of robotic surgery in gynecologic oncology may impact fellowship training. The purpose of this study was to review the proportion of robotic procedures performed by fellows at the console, and compare operative times and lymph node yields to faculty surgeons.


METHODS
A prospective database of women undergoing robotic gynecologic surgery has been maintained since 2008. Intra-operative datasheets completed include surgical times and primary surgeon at the console. Operative times were compared between faculty and fellows for simple hysterectomy (SH), bilateral salpingo-oophorectomy (BSO), pelvic (PLND) and paraaortic lymph node dissection (PALND) and vaginal cuff closure (VCC). Lymph nodes counts were also compared.


RESULTS
Times were recorded for 239 SH, 43 BSOs, 105 right PLNDs, 104 left PLNDs, 34 PALND and 269 VCC. Comparing 2008 to 2011, procedures performed by the fellow significantly increased; SH 16% to 83% (p<0.001), BSO 7% to 75% (p=0.005), right PLND 4% to 44% (p<0.001), left PLND 0% to 56% (p<0.001), and VCC 59% to 82% (p=0.024). Console times (min) were similar for SH (60 vs. 63, p=0.73), BSO (48 vs. 43, p=0.55), and VCC (20 vs. 22, p=0.26). Faculty times (min) were shorter for PLND (right 26 vs. 30, p=0.04, left 23 vs. 27, p=0.02). Nodal counts were not significantly different (right 7 vs. 8, p=0.17 or left 7 vs. 7, p=0.87).


CONCLUSIONS
Robotic surgery can be successfully incorporated into gynecologic oncology fellowship training. With increased exposure to robotic surgery, fellows had similar operative times and lymph node yields as faculty surgeons.
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: psoliman@mdanderson.org.
Pamela T
PT
Soliman
David
D
Iglesias
Mark F
MF
Munsell
Michael
M
Frumovitz
Shannon N
SN
Westin
Alpa M
AM
Nick
Kathleen M
KM
Schmeler
Pedro T
PT
Ramirez
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005257:Fellowships and Scholarships; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education* / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000193:education / Q000379:methods; D008197:Lymph Node Excision / Q000193:education / Q000379:methods; D008495:Medical Oncology / Q000193:education*; D008875:Middle Aged; D010052:Ovariectomy / Q000193:education / Q000379:methods; D012371:Robotics / Q000193:education*; D055815:Young Adult
Fellowship training; Gynecologic cancers; Learning curve; Minimally invasive surgery; Robotic surgery