Robotic Cardiac Surgery: Impact Of A New Patient-side Assistant On Outcomes
Husam H. Balkhy, Mackenzie McCrory, Dorothy Krienbring, Sarah Nisivaco, Hiroto Kitahara, Brooke Patel.
University of Chicago Medicine, Chicago, IL, USA.
OBJECTIVE: Numerous studies have emphasized the importance of the experience and training of the console robotic surgeon to achieving good outcomes. Very few studies have focused on the patient-side assistant’s experience level. We investigated whether the retirement of a highly experienced robotic patient-side assistant and replacement with a new assistant had an effect on robotic cardiac surgical outcomes.
METHODS: We performed 989 robotic cardiac surgical procedures (single-surgeon) over a 9 year period (1/2007-12/2016). In 4/2016 the established patient-side assistant retired after spending 8 months training a new patient-side assistant. A retrospective analysis of 216 patients was performed; 108 patients over a 9 month period just prior to arrival of the new patient-side assistant (Group 1), and 108 patients over 8 months just subsequent to departure of the established assistant (Group 2). Case distribution, preoperative characteristics and surgical outcomes were collected and compared.
RESULTS: The experienced assistant had performed 762 prior robotic procedures. The new assistant had 7 years experience in cardiac surgery but no prior robotic experience. The 8 month training period comprised (117) robotic procedures with gradual assumption of responsibility patient-side assisting, starting with off-pump procedures (e.g. ablation and TECAB) and progressing to more demanding on-pump cases (e.g. Mitral Valve and other intra-cardiac procedures). Case volume increased in Group 2. The mean age for Group 1 was slightly lower but otherwise patient demographics were not significantly different. Group 1 had more intra-cardiac cases and group 2 had more triple-vessel TECABs. Outcomes were similar, with the only significant differences being a lower rate of return to OR and lower chest tube drainage in group 2. Results are shown in Table 1.
CONCLUSIONS: We conclude that the transition to a new robotic cardiac surgical patient-side assistant does not have to affect the progress of a busy robotic program. If adequate time for training and gradual assumption of responsibility is ensured, it is feasible to make this transition without loss of volume or compromise in patient outcomes.
|Group 1 (n=108)||Group 2 (n=108)||p value|
|TECAB (off pump) n (x1, x2, x3)||54 (25,28,1)||53 (20,25,8)||0.946|
|Valve/Intracardiac (on pump) n (%)||44 (40)||38 (35)||0.432|
|Other (off pump) n (%)||11 (10)||17 (16)||0.216|
|Mean Robotic time (dock to undock), min||223.8||218.7||0.689|
|Conversion to Sternotomy, n (%)||1 (0.9)||1 (0.9)||.994|
|Mean total chest tube output, mL||878||596||0.004|
|Return to OR, n (%)||4 (3.7)||0||0.045|
|Median Hospital LOS, days||3 (1-12)||3 (1-19)||0.267|
|Mortality||2 (1.8)||1 (0.9)||0.568|
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