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 J. Suman, Travis E. Grotz, Benjamin Zendejas, Jeffrey D. Wayne, Douglas 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

    Cite this

    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 J.; Grotz, Travis E.; Zendejas, Benjamin; Wayne, Jeffrey D.; Tyler, Douglas.

    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, D 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 J. ; Grotz, Travis E. ; Zendejas, Benjamin ; Wayne, Jeffrey D. ; Tyler, Douglas. / 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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    T1 - Training high-volume melanoma surgeons to perform a novel minimally invasive inguinal lymphadenectomy

    T2 - Report of a prospective multi-institutional trial

    AU - Jakub, James W.

    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 J.

    AU - Grotz, Travis E.

    AU - Zendejas, Benjamin

    AU - Wayne, Jeffrey D.

    AU - Tyler, Douglas

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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.

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