OGC P10 Implementation of an Oesophago-Gastric Robotic Programme in a Tertiary Centre and the Evolution to a Structured Training Programme for Career OG Trainees

Abstract

Abstract Background Robotic surgery affords advantages over standard laparoscopic surgery, for both patients and surgeons. Robot-assisted minimally invasive oesophagectomy (RAMIO) has demonstrated shorter operative time and improved lymph node yield (RAMIE trial). Benefits to the surgeon, and patient, include enhanced visualisation, greater precision, and improved ergonomics. During any transition to robotic surgery the need to maintain patient safety and outcomes, especially during the learning curve, is paramount. The impact on training should not be underestimated, with lost opportunities for trainees to develop procedural competence whilst on rotation. We describe the evolution of a robotic oesophago-gastric programme in a tertiary upper GI centre. Methods Implementation began in 2019 with online modules, simulation, and wet-lab workshops. There was external proctorship of the first two consultants for fundoplication then again for thoracic–phase robotic surgery 28 months later. Meanwhile these consultants facilitated the training of consultant colleagues to ensure a whole-team transition to robotics. This rapidly led to the introduction of component-based training of senior trainees in all abdominal aspects of robotic UGI surgery. This will ultimately progress to training career OG cancer surgeons in full RAMIO. Throughout the implementation process, regular audit allowed us to ensure that there was no adverse impact on patient outcomes. Results 246 robotic UGI procedures were performed since September 2020, progressing step-wise from anti-reflux to RAMIO. Initially two consultants were trained, with staged introduction of two others. Subsequently, senior trainees commenced training in sequential components of procedures. Since progression to full RAMIO, the majority (82%) of two-phase oesophagectomies have been robotic. Of non-robotic, one (3%) abdominal conversion for bleeding, one planned open abdomen, and 12% due to a lack of robot access. Introduction of training of non-consultant grades in June 2022 occurred in parallel with thoracic phase training of three consultants. Trainees performed substantial components of 33/130 cases over this time. Conclusions We report the structured, stepwise evolution of an oesophago-gastric robotic programme in a tertiary centre up to full RAMIO with the inclusion of in-house mentoring and training of career OG trainees. Weekly robotic operating lists and high throughput of cases have facilitated uptake across all surgeons and in the majority of cases. The uptake across all consultants has facilitated relatively early on-console training of senior trainees to minimise the impact upon their career development. As an established service with full team engagement, moving forward we anticipate even greater robotic access and trainee involvement.