The impact of the robotic platform on assistant variability in complex gastrointestinal surgery Maureen D. Moore, MD, Cheguevera Afaneh, MD, Katherine D. Gray, MD, Suraj Panjwani, MBBS, Thomas J. Fahey III, MD, Alfons Pomp, MD, and Rasa Zarnegar, MD* Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York article info Article history: Received 9 December 2016 Received in revised form 25 May 2017 Accepted 30 May 2017 Available online xxx Keywords: Nissen fundoplication Assistance Training level Antireflux Robot abstract Background: Nissen fundoplication is considered an advanced minimally invasive procedure whether performed laparoscopically or robotically. In laparoscopic surgery, it is evident that assistant skill level impacts operative times. However, the robotic platform allows improved surgeon autonomy. We aimed to determine the impact of assistant training level on operative times in robotic Nissen fundoplication (RNF) and laparoscopic Nissen fundoplication (LNF). Methods: A prospectively maintained Nissen database (2011-2016) from a single academic institution was utilized to collect patient characteristics, operative times, length of stay, intraoperative complications, postoperative complications, readmission rate, and assistant training level. Assistants were either postgraduate year-3 surgery residents defined as junior-level assistants or a minimally invasive surgery (MIS) fellow defined as senior-level assistants. Results: There were 105 patients included in our analyses. When comparing postgraduate year-3 residents to MIS fellows performing LNF, the median operative time was significantly decreased when senior-level assistants were present in the LNF group, 85 (75-103) versus 129 (74-269) min, P ¼ 0.02. In comparison, median operative times in the RNF group were independent of the assistant’s level of training, 154 (71-300) versus 158 (101-215) min, P ¼ 0.34. There were no significant differences in outcomes between the junior- and senior-level assistant cohorts for estimated blood loss, length of stay, postoperative complications, and 30-d readmission rates in either the LNF or RNF group. Conclusions: Assistant training level impacted operative time for LNF but not RNF. These differences are most likely attributed to increased autonomy of the operating surgeon afforded by the robotic platform reducing assistant variability. ª 2017 Elsevier Inc. All rights reserved. This content has not been published elsewhere. Protocol for the research project has been approved by a suitably constituted Ethics Committee of the institution within which the work was undertaken and that it conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Edinburgh 2000). * Corresponding author. Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, 1300 York Ave, Suite A1027, New York, NY 10065. Tel.: þ1 212 746-5187; fax: þ1 212 746-9948. E-mail address: raz2002@med.cornell.edu (R. Zarnegar). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  november 2017 (219) 98 e102 0022-4804/$ e see front matter ª 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2017.05.127