Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

Thijs de Rooij; Jony van Hilst; Djamila Boerma; Bert A. Bonsing; Freek Daams; Ronald M. van Dam; Marcel G. Dijkgraaf; Casper H. van Eijck; Sebastiaan Festen; Michael F. Gerhards; Bas Groot Koerkamp; Erwin van der Harst; Ignace H. de Hingh; Geert Kazemier; Joost Klaase; Ruben H. de Kleine; Cornelis J. van Laarhoven; Daan J. Lips; Misha D. Luyer; I. Quintus Molenaar; Gijs A. Patijn; Daphne Roos; Joris J. Scheepers; George P. van der Schelling; Pascal Steenvoorde; Menno R. Vriens; Jan H. Wijsman; Dirk J. Gouma; Olivier R. Busch; Mohammed Abu Hilal; Marc G. Besselink

doi:10.1097/SLA.0000000000001888

Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

Thijs de Rooij^*, Jony van Hilst, Djamila Boerma, Bert A. Bonsing, Freek Daams, Ronald M. van Dam, Marcel G. Dijkgraaf, Casper H. van Eijck, Sebastiaan Festen, Michael F. Gerhards, Bas Groot Koerkamp, Erwin van der Harst, Ignace H. de Hingh, Geert Kazemier, Joost Klaase, Ruben H. de Kleine, Cornelis J. van Laarhoven, Daan J. Lips, Misha D. Luyer, I. Quintus MolenaarGijs A. Patijn, Daphne Roos, Joris J. Scheepers, George P. van der Schelling, Pascal Steenvoorde, Menno R. Vriens, Jan H. Wijsman, Dirk J. Gouma, Olivier R. Busch, Mohammed Abu Hilal, Marc G. Besselink

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown.Methods:From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015).Results:In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P <0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P <0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P <0.001). Thirty-day mortality was 3% vs 0% (P = 0.12).Conclusion:A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.

Original language	English
Pages (from-to)	754-762
Journal	Annals of Surgery
Volume	264
Issue number	5
DOIs	https://doi.org/10.1097/SLA.0000000000001888
Publication status	Published - Nov 2016

Keywords

distal pancreatectomy
laparoscopic surgery
pancreatectomy
pancreatic cancer
pancreatic disease
pancreatic surgery
robot-assisted surgery
training

Access to Document

10.1097/SLA.0000000000001888

Cite this

de Rooij, T., van Hilst, J., Boerma, D., Bonsing, B. A., Daams, F., van Dam, R. M., Dijkgraaf, M. G., van Eijck, C. H., Festen, S., Gerhards, M. F., Koerkamp, B. G., van der Harst, E., de Hingh, I. H., Kazemier, G., Klaase, J., de Kleine, R. H., van Laarhoven, C. J., Lips, D. J., Luyer, M. D., ... Besselink, M. G. (2016). Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS). Annals of Surgery, 264(5), 754-762. https://doi.org/10.1097/SLA.0000000000001888

@article{9dedb850b41848388b84e9de409630e9,

title = "Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)",

abstract = "Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown.Methods:From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015).Results:In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P <0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P <0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P <0.001). Thirty-day mortality was 3% vs 0% (P = 0.12).Conclusion:A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.",

keywords = "distal pancreatectomy, laparoscopic surgery, pancreatectomy, pancreatic cancer, pancreatic disease, pancreatic surgery, robot-assisted surgery, training",

author = "{de Rooij}, Thijs and {van Hilst}, Jony and Djamila Boerma and Bonsing, {Bert A.} and Freek Daams and {van Dam}, {Ronald M.} and Dijkgraaf, {Marcel G.} and {van Eijck}, {Casper H.} and Sebastiaan Festen and Gerhards, {Michael F.} and Koerkamp, {Bas Groot} and {van der Harst}, Erwin and {de Hingh}, {Ignace H.} and Geert Kazemier and Joost Klaase and {de Kleine}, {Ruben H.} and {van Laarhoven}, {Cornelis J.} and Lips, {Daan J.} and Luyer, {Misha D.} and Molenaar, {I. Quintus} and Patijn, {Gijs A.} and Daphne Roos and Scheepers, {Joris J.} and {van der Schelling}, {George P.} and Pascal Steenvoorde and Vriens, {Menno R.} and Wijsman, {Jan H.} and Gouma, {Dirk J.} and Busch, {Olivier R.} and Hilal, {Mohammed Abu} and Besselink, {Marc G.}",

year = "2016",

month = nov,

doi = "10.1097/SLA.0000000000001888",

language = "English",

volume = "264",

pages = "754--762",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "5",

}

de Rooij, T, van Hilst, J, Boerma, D, Bonsing, BA, Daams, F, van Dam, RM, Dijkgraaf, MG, van Eijck, CH, Festen, S, Gerhards, MF, Koerkamp, BG, van der Harst, E, de Hingh, IH, Kazemier, G, Klaase, J, de Kleine, RH, van Laarhoven, CJ, Lips, DJ, Luyer, MD, Molenaar, IQ, Patijn, GA, Roos, D, Scheepers, JJ, van der Schelling, GP, Steenvoorde, P, Vriens, MR, Wijsman, JH, Gouma, DJ, Busch, OR, Hilal, MA & Besselink, MG 2016, 'Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)', Annals of Surgery, vol. 264, no. 5, pp. 754-762. https://doi.org/10.1097/SLA.0000000000001888

TY - JOUR

T1 - Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

AU - de Rooij, Thijs

AU - van Hilst, Jony

AU - Boerma, Djamila

AU - Bonsing, Bert A.

AU - Daams, Freek

AU - van Dam, Ronald M.

AU - Dijkgraaf, Marcel G.

AU - van Eijck, Casper H.

AU - Festen, Sebastiaan

AU - Gerhards, Michael F.

AU - Koerkamp, Bas Groot

AU - van der Harst, Erwin

AU - de Hingh, Ignace H.

AU - Kazemier, Geert

AU - Klaase, Joost

AU - de Kleine, Ruben H.

AU - van Laarhoven, Cornelis J.

AU - Lips, Daan J.

AU - Luyer, Misha D.

AU - Molenaar, I. Quintus

AU - Patijn, Gijs A.

AU - Roos, Daphne

AU - Scheepers, Joris J.

AU - van der Schelling, George P.

AU - Steenvoorde, Pascal

AU - Vriens, Menno R.

AU - Wijsman, Jan H.

AU - Gouma, Dirk J.

AU - Busch, Olivier R.

AU - Hilal, Mohammed Abu

AU - Besselink, Marc G.

PY - 2016/11

Y1 - 2016/11

N2 - Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown.Methods:From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015).Results:In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P <0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P <0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P <0.001). Thirty-day mortality was 3% vs 0% (P = 0.12).Conclusion:A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.

AB - Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown.Methods:From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015).Results:In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P <0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P <0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P <0.001). Thirty-day mortality was 3% vs 0% (P = 0.12).Conclusion:A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.

KW - distal pancreatectomy

KW - laparoscopic surgery

KW - pancreatectomy

KW - pancreatic cancer

KW - pancreatic disease

KW - pancreatic surgery

KW - robot-assisted surgery

KW - training

U2 - 10.1097/SLA.0000000000001888

DO - 10.1097/SLA.0000000000001888

M3 - Article

C2 - 27741008

SN - 0003-4932

VL - 264

SP - 754

EP - 762

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -