title: Training High-Volume Melanoma Surgeons to Perform a Novel Minimally Invasive Inguinal Lymphadenectomy: Report of a Prospective Multi-Institutional Trial.
abstract: BACKGROUND
  Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently.
  
  
  METHODS
  A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure.
  
  
  RESULTS
  Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18%]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%; p = 0.038); however, this did not remain significant after controlling for surgeon.
  
  
  CONCLUSIONS
  After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: jakub.james@mayo.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.affiliation: Department of Surgery, Ohio State University Medical Center, Columbus, OH.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Terando
authors.affiliation: Department of Surgery, H Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Amod
authors.initials: A
authors.lastname: Sarnaik
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Ariyan
authors.affiliation: Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC.
authors.forename: Sabino
authors.initials: S
authors.lastname: Zani
authors.affiliation: Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.affiliation: Department of Surgery, Mayo Clinic, Phoenix, AZ.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Farma
authors.affiliation: Department of Surgery, MetroHealth Medical Center, Cleveland, OH.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Averbook
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Jacob B Jake
authors.initials: JB
authors.lastname: Allred
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Vera J
authors.initials: VJ
authors.lastname: Suman
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Travis E
authors.initials: TE
authors.lastname: Grotz
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D005240:Feasibility Studies; D061847:Hospitals, High-Volume; D006801:Humans; D007264:Inguinal Canal; D059032:Learning Curve; D008197:Lymph Node Excision / Q000193:education* / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D014481:United States