title: Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases.
abstract: BACKGROUND
  Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques.
  
  
  OBJECTIVE
  The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy.
  
  
  METHODS
  University Hospital.
  
  
  METHODS
  We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed.
  
  
  RESULTS
  Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0-122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent.
  
  
  CONCLUSIONS
  Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot's enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: Brett.Ecker@uphs.upenn.edu.
authors.forename: Brett L
authors.initials: BL
authors.lastname: Ecker
authors.affiliation: Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Maduka
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Ramdon
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Dempsey
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D004503:Education, Medical, Graduate / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000191:economics / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D010535:Laparoscopy / Q000191:economics / Q000193:education*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000193:education*; D055815:Young Adult
keywords: Bariatric Surgery; Morbid Obesity; Robotic surgery; Sleeve gastrectomy; Surgical education