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Autonomy of Robotic Platform Allows for Reduced Requirement for Expert Assistance in Minimally Invasive Anti-Reflux Surgery
Maureen D. Moore*, Renee Tholey, Suraj Panjwani, Jonathan S. Abelson, Cheguevera Afaneh, Thomas J. Fahey, Alfons Pomp, Rasa Zarnegar
Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY
Background:
Nissen fundoplication is considered an advanced minimally invasive procedure whether performed laparoscopically or robotically. In laparoscopic surgery, it is evident that assistant skill level impacts operative times. However, the robotic platform allows improved surgeon autonomy. We aimed to determine the impact of assistant training level on operative times in robotic and laparoscopic Nissen fundoplication.
Methods:
A prospectively maintained Nissen database (2011-2015) from a single academic institution was utilized to collect patient characteristics, operative times, length of stay, intraoperative complications, postoperative complications, readmission rate, and assistant training level. Assistants were either post-graduate year 3 surgery residents (PGY III) or a minimally invasive surgery (MIS) fellow.
Results:
There were 99 patients included in our analyses. When comparing PGY III residents to MIS fellows performing laparoscopic Nissen fundoplication, the operative times decreased markedly (141.7 +/- 51.4 vs 111.6 +/- 37.5 mins, p=0.04). In comparison, operative times of robotic Nissen fundoplication did not differ between PGY III residents and MIS fellows (151.6 +/- 43.4 vs 150.7 +/-36.7 mins, p=0.95). Patient characteristics were not significantly different between the groups except for BMI, which was higher in the MIS fellow cases overall versus the PGY III residents cases (p=0.03), as well as in the laparoscopic group overall when compared to the robotic group (p=0.001). There were no significant differences in intraoperative complication rate (P=0.27), post-operative complication rate (P=0.40), and readmission rate (P=0.39) based on training level.
Conclusion:
Assistant training level impacted operative time for laparoscopic but not robotic Nissen fundoplication. These differences are most likely attributed to increased autonomy of the operating surgeon afforded by the robotic platform negating assistant variability.
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