Training High-Volume Melanoma Surgeons to Perform a Novel Minimally Invasive Inguinal Lymphadenectomy: Report of a Prospective Multi-Institutional Trial.

Journal Article

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.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.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.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.

Full Text

Duke Authors

Cited Authors

  • Jakub, JW; Terando, AM; Sarnaik, A; Ariyan, CE; Faries, MB; Zani, S; Neuman, HB; Wasif, N; Farma, JM; Averbook, BJ; Bilimoria, KY; Allred, JBJ; Suman, VJ; Grotz, TE; Zendejas, B; Wayne, JD; Tyler, DS

Published Date

  • March 2016

Published In

Volume / Issue

  • 222 / 3

Start / End Page

  • 253 - 260

PubMed ID

  • 26711792

Electronic International Standard Serial Number (EISSN)

  • 1879-1190

International Standard Serial Number (ISSN)

  • 1072-7515

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2015.11.010

Language

  • eng