Introducing a novice surgeon to an experienced robotic gynaecological oncology team: an observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery.

Objective: Effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team. Design: Observational cohort study. Setting: Tertiary referral centre. Population Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all patients over three groups: early learning phase of 61 procedures (group 1), experienced phase of the 104 procedures thereafter (group 2), and the final 61 procedures during introduction of a novice with structured training (group 3). Methods: Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed and patient outcomes between groups were compared. Main Outcome Measures Surgical proficiency based on recurrence, surgical and oncological outcomes. Results: Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 ( p <0.001) and similar to group 2 ( p =0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. Conclusions: Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.