The influence of proficiency-based progression training on peri-operative and survival outcomes in robot-assisted laparoscopic surgery for endometrial cancer: an observational cohort study.

Objective: To assess the influence of proficiency-based progression (PBP) training in robot-assisted laparoscopic (RAL) surgery for endometrial cancer on peri-operative and survival outcomes. Design: Observational cohort study. Setting: Tertiary referral and subspecialty training centre. Population All women with primary endometrial cancer treated with RAL surgery between 2015 and 2022. Methods: Proficiency-based progression training cases were identified pre-operatively by consultant surgeons based on clinical factors, such as BMI and comorbidities, and case complexity matching the experience of the trainee. Main Outcome Measures Intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theatre rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Results: Training cases had a lower BMI than non-training cases (30 versus 32 kg/m 2 ), but were comparable in age, performance status and comorbidities. Training had no influence on intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theatre rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min). Estimated blood loss, conversion rates, CCU-admissions and lymphoedema rates were comparable. Conclusions: Proficiency based progression training can be safely used to teach RAL surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of RAL surgery performed by a trainee on endometrial cancer outcomes.