Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy: Report of a prospective multi-institutional trial

James W Jakub, Alicia M. Terando, Amod Sarnaik, Charlotte E. Ariyan, Mark B. Faries, Sabino Zani, Heather B. Neuman, Nabil Wasif, Jeffrey M. Farma, Bruce J. Averbook, Karl Y. Bilimoria, Jacob B. Allred, Vera Jean Suman, Travis E. Grotz, Benjamin Zendejas, Jeffrey D. Wayne, Douglas S. Tyler

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. Study Design A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure. Results Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18%]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%; p = 0.038); however, this did not remain significant after controlling for surgeon. Conclusions After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.

Original languageEnglish (US)
Pages (from-to)253-260
Number of pages8
JournalJournal of the American College of Surgeons
Volume222
Issue number3
DOIs
StatePublished - Mar 1 2016

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Groin
Lymph Node Excision
Melanoma
Operative Time
Lymph Nodes
Education
Surgeons
Feasibility Studies
Morbidity

ASJC Scopus subject areas

  • Surgery

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Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy : Report of a prospective multi-institutional trial. / Jakub, James W; Terando, Alicia M.; Sarnaik, Amod; Ariyan, Charlotte E.; Faries, Mark B.; Zani, Sabino; Neuman, Heather B.; Wasif, Nabil; Farma, Jeffrey M.; Averbook, Bruce J.; Bilimoria, Karl Y.; Allred, Jacob B.; Suman, Vera Jean; Grotz, Travis E.; Zendejas, Benjamin; Wayne, Jeffrey D.; Tyler, Douglas S.

In: Journal of the American College of Surgeons, Vol. 222, No. 3, 01.03.2016, p. 253-260.

Research output: Contribution to journalArticle

Jakub, JW, Terando, AM, Sarnaik, A, Ariyan, CE, Faries, MB, Zani, S, Neuman, HB, Wasif, N, Farma, JM, Averbook, BJ, Bilimoria, KY, Allred, JB, Suman, VJ, Grotz, TE, Zendejas, B, Wayne, JD & Tyler, DS 2016, 'Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy: Report of a prospective multi-institutional trial', Journal of the American College of Surgeons, vol. 222, no. 3, pp. 253-260. https://doi.org/10.1016/j.jamcollsurg.2015.11.010
Jakub, James W ; Terando, Alicia M. ; Sarnaik, Amod ; Ariyan, Charlotte E. ; Faries, Mark B. ; Zani, Sabino ; Neuman, Heather B. ; Wasif, Nabil ; Farma, Jeffrey M. ; Averbook, Bruce J. ; Bilimoria, Karl Y. ; Allred, Jacob B. ; Suman, Vera Jean ; Grotz, Travis E. ; Zendejas, Benjamin ; Wayne, Jeffrey D. ; Tyler, Douglas S. / Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy : Report of a prospective multi-institutional trial. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 3. pp. 253-260.
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abstract = "Background Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. Study Design A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure. Results Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83{\%}). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18{\%}]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3{\%}; p = 0.038); however, this did not remain significant after controlling for surgeon. Conclusions After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.",
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AU - Terando, Alicia M.

AU - Sarnaik, Amod

AU - Ariyan, Charlotte E.

AU - Faries, Mark B.

AU - Zani, Sabino

AU - Neuman, Heather B.

AU - Wasif, Nabil

AU - Farma, Jeffrey M.

AU - Averbook, Bruce J.

AU - Bilimoria, Karl Y.

AU - Allred, Jacob B.

AU - Suman, Vera Jean

AU - Grotz, Travis E.

AU - Zendejas, Benjamin

AU - Wayne, Jeffrey D.

AU - Tyler, Douglas S.

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N2 - Background Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. Study Design A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure. Results Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18%]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%; p = 0.038); however, this did not remain significant after controlling for surgeon. Conclusions After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.

AB - Background Minimally invasive inguinal lymphadenectomy (MILND) is a novel procedure with the potential to decrease surgical morbidity compared with the traditional open approach. The current study examined the feasibility of a combined didactic and hands-on training program to prepare high-volume melanoma surgeons to perform this procedure safely and proficiently. Study Design A select group of melanoma surgeons with no MILND experience were recruited. After completing a structured training program, surgeons enrolled patients with melanoma who required inguinal lymphadenectomy and performed the procedure in the minimally invasive fashion. A proficiency score composed of lymph node yield, operative time, and blood loss (or adverse events) was assigned for each case. After performing six cases, surgeons meeting a threshold score were considered proficient in the procedure. Results Twelve surgeons from 10 institutions enrolled 88 patients. The majority of surgeons were deemed proficient within 6 cases (83%). No differences in operative time or lymph node yield were noted during the course of the study. The rate of conversion was higher during an individual surgeon's early experience (9 of 49 [18%]), and only 1 procedure was converted in the 39 cases performed after a surgeon had performed 5 cases (late conversion rate, 3%; p = 0.038); however, this did not remain significant after controlling for surgeon. Conclusions After a structured training program, experienced melanoma surgeons adopted a novel surgical technique with acceptable operative times, conversions, and lymph node yield. Eighty-four percent of the surgeons who completed at least 6 MILND procedures were considered proficient based on our predetermined definition.

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