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Seniority of the assistant surgeon and perioperative outcomes in robotic-assisted proctectomy for rectal cancer

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Abstract

The background of this study is to evaluate the impact of the assistant surgeon's in robotic-assisted proctectomy (RAP) on perioperative outcomes. A retrospective analysis of all patients who underwent RAP for rectal adenocarcinoma between 2011 and 2020 was conducted. Patient cohort was divided into three groups based on the assistant surgeon’s training level: post-graduate years (PGY) 1–3 surgical residents (Group 1), PGY 4–5 surgical residents (Group 2), and board-certified general surgeons (Group 3). Overall, 175 patients were included in the study: 29 patients (17%) in Group 1, 84 (48%) in Group 2, and 62 (35%) in Group 3. The median tumor distance from the anal verge was 8 cm in all groups (p = 0.73). The median operative time was similar across all groups: 290, 291, and 281 min in Groups 1, 2, and 3, respectively (p = 0.69). In a multivariable analysis, the lack of association between assistant training level and procedure time maintained when adjusting for the year of operation (p = 0.84). Patients operated with junior residents as assistant surgeons (Group 1) had a more postoperative complications (p = 0.01) and a slightly longer hospital length of stay [7 days, interquartile range (IQR) 3], compared to those operated by assistant surgeons that were senior residents or attendings (6 IQR 2.5, and 6 IQR 2 in Groups 2 and 3, respectively; p = 0.02). Conversion rates (p = 0.12), intraoperative complications (p = 0.39), major postoperative complications (Clavien–Dindo ≥ 3; p = 0.32), 30-day readmission (p = 0.45), and mortality (p = 0.99) were similar between the groups. Robotic-assisted proctectomy performed with the assistance of a junior resident was found to be correlated with worse postoperative outcomes compared to more experienced assistants. No difference was seen in intraoperative outcomes.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

Aspects of this study were done in collaboration with the Arrow Project at Sheba Medical Center, Tel-Hashomer, Israel. The authors wish to thank Dr. Yasmin Abu-Ghanem for her assistance in study design and interpretation.

Funding

This study has received no funding or financial support.

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Author notes

  1. Nir Horesh and Marat Khaikin have equally contributed to this work.

Authors and Affiliations

  1. Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Mai Shiber, Roi Anteby, Benjamin Russell, Yaniv Zager, Mordechai Gutman, Ido Nachmany, Nir Horesh & Marat Khaikin

  2. Faculty of Medicine, Ariel University, Ariel, Israel

    Mai Shiber

  3. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Nir Horesh

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  1. Mai Shiber
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Contributions

MS—study conception and design, acquisition of data, and drafting of manuscript. RA—Study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript. BR—acquisition of data, analysis and interpretation of data, and drafting of manuscript. YZ—acquisition of data, analysis and interpretation of data, and drafting of manuscript. MG—study conception and design, drafting of manuscript, and critical revision of manuscript. IN—analysis and interpretation of data, and critical revision of manuscript. NH—study conception and design, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript. MK—study conception and design, drafting of manuscript, and critical revision of manuscript.

Corresponding author

Correspondence to Nir Horesh.

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The authors have no related conflict of interest to declare.

Ethical approval

Ethical approval to conduct this study was granted by the institutional review board of our institute. Informed consent was waived by the institutional review board for this study.

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Department of General Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

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Shiber, M., Anteby, R., Russell, B. et al. Seniority of the assistant surgeon and perioperative outcomes in robotic-assisted proctectomy for rectal cancer. J Robotic Surg 17, 1097–1104 (2023). https://doi.org/10.1007/s11701-022-01515-5

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