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Wang TN, Woelfel IA, Huang E, Pieper H, Meara MP, Chen X(P. Behind the pattern: General surgery residsent autonomy in robotic surgery. Heliyon 2024; 10:e31691. [PMID: 38841510 PMCID: PMC11152925 DOI: 10.1016/j.heliyon.2024.e31691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Robotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents' opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). Methods General surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2-5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. Results Resident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons' perceived operative time pressure inversely affected resident ICT. Conclusions This study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.
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Affiliation(s)
- Theresa N. Wang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Ingrid A. Woelfel
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Emily Huang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Heidi Pieper
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Michael P. Meara
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
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2
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Wong SW, Crowe P. Cognitive ergonomics and robotic surgery. J Robot Surg 2024; 18:110. [PMID: 38441814 PMCID: PMC10914881 DOI: 10.1007/s11701-024-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
Cognitive ergonomics refer to mental resources and is associated with memory, sensory motor response, and perception. Cognitive workload (CWL) involves use of working memory (mental strain and effort) to complete a task. The three types of cognitive loads have been divided into intrinsic (dependent on complexity and expertise), extraneous (the presentation of tasks) and germane (the learning process) components. The effect of robotic surgery on CWL is complex because the postural, visualisation, and manipulation ergonomic benefits for the surgeon may be offset by the disadvantages associated with team separation and reduced situation awareness. Physical fatigue and workflow disruptions have a negative impact on CWL. Intraoperative CWL can be measured subjectively post hoc with the use of self-reported instruments or objectively with real-time physiological response metrics. Cognitive training can play a crucial role in the process of skill acquisition during the three stages of motor learning: from cognitive to integrative and then to autonomous. Mentorship, technical practice and watching videos are the most common traditional cognitive training methods in surgery. Cognitive training can also occur with computer-based cognitive simulation, mental rehearsal, and cognitive task analysis. Assessment of cognitive skills may offer a more effective way to differentiate robotic expertise level than automated performance (tool-based) metrics.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia
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3
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Kim MP, Del Calvo H, Chihara R, Chan EY. Video-based curriculum improves resident participation during robot-assisted surgery. J Thorac Dis 2022; 14:4641-4649. [PMID: 36647487 PMCID: PMC9840057 DOI: 10.21037/jtd-22-603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
Background Surgical videos allow residents to prepare for the operating room. We sought to determine if a video-based curriculum improves resident participation during robot-assisted surgery. Methods We created a video-based surgical curriculum by providing residents with narrated videos of similar cases before participating in the operating room. We obtained information about the average monthly viewings of cases and the total monthly time spent viewing cases. We surveyed the residents after a year of the program. In addition, we used software to track the amount of time the resident spent controlling the robot during the case. We assessed the amount of time the resident had control of the robot for their first robot-assisted hiatal hernia repair of the month with a dual console for 13 months before and after implementing the curriculum. Results A total of 43 videos were made for the video-based curriculum. On average, 37 videos were viewed during the month, with residents spending 16 hours per month viewing the videos. Twenty residents (83%) completed the survey. 90% of the residents often or always watched the video before surgery. All residents felt videos were better than books to prepare for surgery (100%). Residents thought that the videos helped them prepare for surgery: understanding surgical anatomy (95%), the cognitive aspect of the surgery (95%), and the technical part of surgery (100%). Analysis of the resident console time of the first robot-assisted hiatal hernia repair of the month showed a significant increase in the amount of time the resident participated in the case from 11% to 48% (P<0.001). Conclusions Video-based curriculum was a valuable tool for residents to prepare for surgical cases. Video-based curriculum significantly increases resident participation during robot-assisted thoracic surgery. Adopting this strategy will improve the resident training experience. A video-based curriculum should be adopted in surgical education.
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Affiliation(s)
- Min P. Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA;,Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Haydee Del Calvo
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Ray Chihara
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA;,Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Edward Y. Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA;,Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
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4
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Green CA, Lin J, Higgins R, O'Sullivan PS, Huang E. Expertise in perception during robotic surgery (ExPeRtS): What we see and what we say. Am J Surg 2022; 224:908-913. [DOI: 10.1016/j.amjsurg.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
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5
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Bergmann J, Lehmann-Dorl B, Witt L, Aselmann H. Using the da Vinci X® - System for Esophageal Surgery. JSLS 2022; 26:JSLS.2022.00018. [PMID: 35815328 PMCID: PMC9255263 DOI: 10.4293/jsls.2022.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Robotic esophageal surgery is becoming more widely adopted. Several publications on the feasibility, short-term outcomes and technical aspects are available. Most of these articles used either the da Vinci® SI system or in newer series the Xi System. The da Vinci® X system is generally considered less suited for multiquadrant access like in esophageal surgery, hence only limited data is available. Here we describe our initial experience with 16 Ivor-Lewis robotic assisted minimally invasive esophagectomies (RAMIE) in patients with esophageal adenocarcinoma. The da Vinci® X system was installed in our department in 2019; the robotic program comprises colorectal, pancreatic and esophageal surgery. The first two patients were operated in the presence of a proctor. An operative standard was established including fluorescence angiography (Firefly®). Technical aspects with focus on the characteristics of the da Vinci® X system, operating room setup, and short-term outcomes are discussed.
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Affiliation(s)
- Juri Bergmann
- General-, Visceral and Vascular Surgery, KRH Klinikum Robert Koch, Gehrden, Germany
| | | | - Lars Witt
- Anesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany
| | - Heiko Aselmann
- General-, Visceral and Vascular Surgery, KRH Klinikum Robert Koch, Gehrden, Germany
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6
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de’Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg 2022; 17:4. [PMID: 35057836 PMCID: PMC8781145 DOI: 10.1186/s13017-022-00410-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery.
Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus.
Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.
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7
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Leon MG, Carrubba AR, DeStephano CC, Heckman MG, Craver EC, Dinh TA. Impact of robotic single and dual console systems in the training of minimally invasive gynecology surgery (MIGS) fellows. J Robot Surg 2022; 16:1273-1280. [PMID: 35025036 DOI: 10.1007/s11701-022-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The advantages of dual console use in robotic surgical education have not been described. The aims of this study are to compare fellow console time, surgical steps performed, and surgical takeovers between attending and fellow surgeons using dual versus single console robotic systems. Participants included minimally invasive gynecologic surgery (MIGS) fellows (N = 3) and subspecialty trained gynecologic surgeons (N = 5). Prospective data were obtained on 126 patients (N = 77 single console, N = 49 dual console) undergoing robotic hysterectomy. Variables included demographics, surgical characteristics (fellow, month of fellowship, attending surgeon, concomitant oophorectomy, additional surgical procedures, estimated blood loss, specimen weight), and outcomes (console time, docking time, console time/docking time ratio, total case time, number of surgical steps performed by the fellow, number of surgical takeovers, complications). After controlling for potential confounders, fellows spent a mean of 25.8 min longer (P < 0.001) at the console in dual console operations compared to single. Dual console surgeries had a greater number of steps performed by the fellow (OR[> 5 steps]: 3.37, P = 0.009), a higher console time/docking time ratio (P < 0.001), and more surgical takeovers between fellow and attending (OR [> 1 takeover]: 3.53, P < 0.001). There were no significant differences between the two groups regarding docking time (P = 0.15), case time (P = 0.79), or complications (P = 0.30). Our findings suggest dual console robotic training provide fellows the opportunity for more "hands-on" experience with longer console time, higher number of surgical steps performed, and added interaction with the attending surgeon when compared with single console training. These surgical metrics provide objectivity in competency-based robotic training without increasing the complications or surgical time.
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Affiliation(s)
- Mateo G Leon
- McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St # 1014, Houston, TX, 77030, USA.
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
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8
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Yamamoto M, Ashida K, Hara K, Sugezawa K, Uejima C, Tanio A, Shishido Y, Miyatani K, Hanaki T, Kihara K, Matsunaga T, Tokuyasu N, Sakamoto T, Fujiwara Y. Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System. Yonago Acta Med 2021; 64:240-248. [PMID: 34429701 PMCID: PMC8380558 DOI: 10.33160/yam.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. METHODS We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. RESULTS The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. CONCLUSION Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.
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Affiliation(s)
- Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Keigo Ashida
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kazushi Hara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Ken Sugezawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Chihiro Uejima
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Akimitsu Tanio
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Shakir NA, Zhao LC. Robotic-assisted genitourinary reconstruction: current state and future directions. Ther Adv Urol 2021; 13:17562872211037111. [PMID: 34377155 PMCID: PMC8326819 DOI: 10.1177/17562872211037111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques.
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Affiliation(s)
- Nabeel A Shakir
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, 222 41st Street, 11th Floor, New York, NY 10017, USA
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10
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Spampinato G, Binet A, Fourcade L, Mendoza Sagaon M, Villemagne T, Braik K, Grosos C, Lardy H, Ballouhey Q. Comparison of the Learning Curve for Robot-Assisted Laparoscopic Pyeloplasty Between Senior and Junior Surgeons. J Laparoendosc Adv Surg Tech A 2021; 31:478-483. [PMID: 33651635 DOI: 10.1089/lap.2020.0822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: The widespread use of robotic surgery has provided surgeons a high-quality and alternative method to perform pyeloplasty. Indeed, robot-assisted technology has made it a lot easier to obtain the advanced technical skills required to perform this procedure. The learning curve (LC) reflects the increase in learning as a function of experience. Robot-assisted laparoscopic pyeloplasty (RALP) represents a well-standardized and reproducible procedure with an LC that allows reliable results to readily be obtained. The aim of our study was to compare the RALP LC of senior versus junior surgeons. Materials and Methods: We reviewed all of the RALP procedures performed at three pediatric surgery centers between November 2007 and November 2018. Three senior surgeons and 4 junior surgeons performed the robotic procedures. Neither the senior nor the junior surgeons had previous experience with robotic surgery; they had experience with conventional laparoscopic procedures but not with laparoscopic pyeloplasty. The primary metric that we selected to evaluate competence acquisition was a composite outcome defined by a combination of operative time (OT), complications, and surgical success. The complications were rated according to the Clavien-Dindo classification expressed by a complication factor; surgical success was expressed as a success factor, and we used a cumulative sum (CUSUM) analysis to determine the LC. The CUSUM method, through its multioutcome approach, is a very effective way to evaluate LCs. Results: Between November 2007 and November 2018, 3 senior surgeons and 4 junior surgeons performed 88 RALP procedures. The included patients had a median age of 6.1 years (range 7 months-16 years). The median duration of follow-up was 6.4 years (range 14 months-12 years). The median OT was 198.86 minutes (range 106-335 minutes). By CUSUM analysis of the composite outcome, we found that despite the junior surgeons having performed fewer procedures than the senior surgeons, their LCs exhibited an earlier inflection point (Fig. 1) followed by a constant rate of improvement in proficiency, thus indicating a more rapid learning process. The median composite scores for the senior surgeons and the junior surgeons were 299 (range 210-370) and 193 (range 131-255), respectively, after seven procedures. Conclusion: Assuming proper exposure to robotics and an adequate case volume, we demonstrated that junior surgeons can readily achieve comparable levels of expertise compared with senior practitioners in the field of pediatric RALP. It can be assumed that the LC in robotic pyeloplasty is not only directly influenced by the individual surgical experience but also by the experience of the surgical team.
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Affiliation(s)
- Grazia Spampinato
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants-CHU de Limoges, Limoges Cedex, France
| | - Aurelien Binet
- Service de Chirurgie Viscérale Pédiatrique, Hôpital de ClochevilleTours Cedex, France
| | - Laurent Fourcade
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants-CHU de Limoges, Limoges Cedex, France
| | - Mario Mendoza Sagaon
- Chirurgia e Ortopedia Pediatrica, Istituto Pediatrico Della Svizzera Italiana, Ospedale regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Thierry Villemagne
- Service de Chirurgie Viscérale Pédiatrique, Hôpital de ClochevilleTours Cedex, France
| | - Karim Braik
- Service de Chirurgie Viscérale Pédiatrique, Hôpital de ClochevilleTours Cedex, France
| | - Celine Grosos
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants-CHU de Limoges, Limoges Cedex, France
| | - Hubert Lardy
- Service de Chirurgie Viscérale Pédiatrique, Hôpital de ClochevilleTours Cedex, France
| | - Quentin Ballouhey
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants-CHU de Limoges, Limoges Cedex, France
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Abstract
Significant improvements have been made in bariatric surgery for the past two decades. Thus, early and late complication rates decreased significantly. Thanks to its promising results, robotic surgery is finding increasing use in the field of surgery and the bariatric surgery is one of these areas. Following the first robotic bariatric surgery in 1997, it continues to be performed at increasing rates thanks to the advantages it brings. Robotic surgery offers new opportunities to improve bariatric surgery, thanks to remote control mechanical arms. The three-dimensional (3D) view, together with the precision of movements and the freedom of arms offer new insights into the more difficult surgeries. Hospitals should prepare a good business plan to financially activate robotic surgery, thus, more robotic procedures can be achieved. Among the expressed concerns for the Da Vinci Systems are issues such as the costs, operational times, and lack of tactile feedback. Annual maintenance fees and instrument costs are undoubtedly higher than laparoscopic surgery methods. Robotic surgery is now integrated into obesity surgery, such as sleeve gastrectomy, Roux-en-Y gastric bypass, one anastomosis gastric bypass, biliopancreatic diversion and single anastomosis duodenal switch. It allows for more efficient and ideal anastomosis and exposure in challenging fields. Robotic bariatric surgery is a safe procedure with a short learning curve, outcomes comparable to laparoscopy and other benefits of robotic technology.
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Affiliation(s)
- Mahir Ozmen
- Department of Surgery, School of Medicine, Istinye University, Istanbul, Turkey - .,Liv Hospital, Ankara, Turkey -
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12
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Devlin CM, Fowler S, Biyani CS, Forster JA. Changes in UK renal oncological surgical practice from 2008 to 2017: implications for cancer service provision and surgical training. BJU Int 2021; 128:206-217. [PMID: 33249738 DOI: 10.1111/bju.15310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine and analyse the temporal changes in oncological nephrectomy practice and training opportunities using data obtained from the UK British Association of Urological Surgeons nephrectomy register from 2008 to 2017. PATIENT AND METHODS All nephrectomies within the dataset for this time period were analysed (n = 54 251). Cases were divided into radical nephrectomy (RN), partial nephrectomy (PN) and nephroureterectomy (NU). Simple nephrectomy, donor nephrectomy and benign PN were excluded. The annual frequencies for each oncological nephrectomy method, surgical approach, grade of surgeon, hospital caseload numbers and short-term surgical outcomes were determined. RESULTS Reported annual nephrectomy numbers increased by 2.5-fold in the 9-year time period. The number of hospitals performing nephrectomies decreased by 22%, however, more than 40% of centres performed more than 70 cases a year. There was a trend towards a decrease in overall length of hospital stay (9 vs 5 days; P < 0.01) and decreased transfusion rates. The proportion of minimally invasive procedures increased from 57% to 75%, with nephron-sparing rates increasing from 8.9% overall to 24.8%. With regard to surgical technique, robot-assisted surgery saw a mean annual increase of 222%. Overall, there was a 10% decrease in the proportion of PNs performed by trainee surgeons. CONCLUSIONS Renal surgery has changed considerably with regard to volume and also surgical approach, with rates of nephron-sparing surgery and minimally invasive surgery significantly increasing. Increasing hospital centralization and institutional experience, and a shift to robot-assisted surgery appear to have contributed to the observed improved patient outcomes. The increasing utilization of robot-assisted surgery has potential implications and challenges for the training of future urology surgeons.
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Affiliation(s)
- Conor M Devlin
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James A Forster
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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13
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Klapczynski C, Sallée C, Tardieu A, Peschot C, Boutot M, Mohand N, Lacorre A, Margueritte F, Gauthier T. Training for next generation surgeons: a pilot study of robot-assisted hysterectomy managed by resident using dual console. Arch Gynecol Obstet 2020; 303:981-986. [PMID: 33180173 DOI: 10.1007/s00404-020-05870-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess feasibility of a standardized robot-assisted hysterectomy managed by resident and supervised by senior surgeon using dual-console on a 21-step grid (max score = 42) assessing resident autonomy. METHODS A total of seven patients managed between September 2019 and March 2020 by six residents in gynecology and obstetrics were included. Standardized robot-assisted hysterectomy for endometrial cancer or adenomyosis was performed. RESULTS No conversion to laparotomy, no intra- or post-operative incidents were reported. Mean score on the evaluation scale was 29.8 out of 42 (SD = 7.3). Mean operative time was 104 min (SD = 23). Mean average suturing time was, respectively, 335 s (SD = 57 s) and 270 s (SD = 53 s) for the first and the fourth knot. There was a 65 s improvement between the first and the fourth intracorporeal knot (p = 0.043). The perceived workload evaluated with the NASA TLX score showed a low level of stress (Temporal demand = 1.6 /10), and a low level of frustration (Frustration level = 3.6/10). Experience gained during the surgery was felt to be important (Commitment = 8.6/10). CONCLUSION Standardized robot-assisted hysterectomy managed by a resident supervised by a senior surgeon using the dual-console seems feasible. This tool could be useful to assess residents' surgical skills.
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Affiliation(s)
- Clémence Klapczynski
- Department of Gynecology, University Hospital of Rouen, 1 rue de Germont Rouen University Hospital, 76000, Rouen, France
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Camille Sallée
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Antoine Tardieu
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Clémence Peschot
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Manon Boutot
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Nadia Mohand
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Aymeline Lacorre
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - François Margueritte
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Tristan Gauthier
- Department of Gynecology, University Hospital of Limoges, Mother and child hospital, 8 avenue Dominique Larrey, 87000, Limoges, France.
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Josef Lindegger D, Alnafisse N, Thomsen ASS, Logeswaran A, Saleh GM. The future of virtual reality in cataract surgical training. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1781619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Nouf Alnafisse
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ann Sofia Skou Thomsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Centre for HR, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | | | - George M. Saleh
- Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, the Department of Education, The UCL Institute of Ophthalmology, London, UK
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15
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McDonnell JM, Ahern DP, Ó Doinn T, Gibbons D, Rodrigues KN, Birch N, Butler JS. Surgeon proficiency in robot-assisted spine surgery. Bone Joint J 2020; 102-B:568-572. [DOI: 10.1302/0301-620x.102b5.bjj-2019-1392.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: Bone Joint J 2020;102-B(5):568–572.
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Affiliation(s)
| | - Daniel P. Ahern
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tiarnan Ó Doinn
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Denys Gibbons
- School of Medicine, Trinity College Dublin, Dublin, Ireland, National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Nick Birch
- The Chris Moody Rehabilitation and Sports Injury Centre, Northampton, UK
| | - Joseph S. Butler
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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16
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Zhao B, Lam J, Hollandsworth HM, Lee AM, Lopez NE, Abbadessa B, Eisenstein S, Cosman BC, Ramamoorthy SL, Parry LA. General surgery training in the era of robotic surgery: a qualitative analysis of perceptions from resident and attending surgeons. Surg Endosc 2020; 34:1712-1721. [PMID: 31286248 PMCID: PMC6946889 DOI: 10.1007/s00464-019-06954-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of the surgical robot has increased annually since its introduction, especially in general surgery. Despite the tremendous increase in utilization, there are currently no validated curricula to train residents in robotic surgery, and the effects of robotic surgery on general surgery residency training are not well defined. In this study, we aim to explore the perceptions of resident and attending surgeons toward robotic surgery education in general surgery residency training. METHODS We performed a qualitative thematic analysis of in-person, one-on-one, semi-structured interviews with general surgery residents and attending surgeons at a large academic health system. Convenient and purposeful sampling was performed in order to ensure diverse demographics, experiences, and opinions were represented. Data were analyzed continuously, and interviews were conducted until thematic saturation was reached, which occurred after 20 residents and seven attendings. RESULTS All interviewees agreed that dual consoles are necessary to maximize the teaching potential of the robotic platform, and the importance of simulation and simulators in robotic surgery education is paramount. However, further work to ensure proper access to simulation resources for residents is necessary. While most recognize that bedside-assist skills are essential, most think its educational value plateaus quickly. Lastly, residents believe that earlier exposure to robotic surgery is necessary and that almost every case has a portion that is level-appropriate for residents to perform on the robot. CONCLUSIONS As robotic surgery transitions from novelty to ubiquity, the importance of effective general surgery robotic surgery training during residency is paramount. Through in-depth interviews, this study provides examples of effective educational tools and techniques, highlights the importance of simulation, and explores opinions regarding the role of the resident in robotic surgery education. We hope the insights gained from this study can be used to develop and/or refine robotic surgery curricula.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA.
| | - Jenny Lam
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Hannah M Hollandsworth
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Arielle M Lee
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Nicole E Lopez
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Benjamin Abbadessa
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Samuel Eisenstein
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Bard C Cosman
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Sonia L Ramamoorthy
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Lisa A Parry
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
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Margueritte F, Sallée C, Legros M, Lacorre A, Piver P, Aubard Y, Tardieu A, Gauthier T. Description of an initiation program to robotic in vivo gynecological surgery for junior surgeons. J Gynecol Obstet Hum Reprod 2019; 49:101627. [PMID: 31499279 DOI: 10.1016/j.jogoh.2019.101627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most gynecological residents or junior surgeons do not practice nor experience robotic surgery due to lack of access during residency or poor knowledge about this growing surgical technology. This study evaluated the feasibility and safety of a 3-half-day experiencing and training session for robot-assisted gynecological surgery designed for residents and fellows. MATERIEL AND METHODS This is a prospective, single-center observational study about a training course aimed at residents or fellows at the university teaching hospital of Limoges (France). It spreads over three consecutive half-days: one dedicated to simulation exercises involving the Da Vinci Skills Simulator© and the other two, to practice in two robot-assisted procedures with dual-console equipment supervised by a senior surgeon (as it is usually performed in a university teaching hospital). Complications during surgery, patient's medical records as well as the participants' performances during in vivo suturing acts were gathered. Feedback on the session was obtained with a questionnaire at the end of the course. RESULTS Twelve sessions involving 24 patients operated on by 34 trainees from 16 different teaching university hospitals across the country took place. No conversion to laparotomy nor any major peri- or post-operative complication was reported. Time for stitching decreased significantly (p=.016) between the first and the second in vivo surgery. Use of the dual console was found helpful and most attendees (96.8%) would recommend this training session. CONCLUSION We showed this training course with both simulation and in vivo surgery was feasible, safe and was a well-liked initiation program for robotic surgery.
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Affiliation(s)
- François Margueritte
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France.
| | - Camille Sallée
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Maxime Legros
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Aymeline Lacorre
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Pascal Piver
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Antoine Tardieu
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
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Zirafa CC, Romano G, Key TH, Davini F, Melfi F. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg 2019; 8:210-217. [PMID: 31032204 DOI: 10.21037/acs.2019.03.03] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Robotic surgery has the features to represent the future of surgery, considering the rapid evolution of its technology and the resulting in the surgical field. In the last years, the robotic technique in thoracic surgery has progressively become widespread in the word, particularly for the treatment of the mediastinal and pulmonary lesions. The development of technology in the robotic system has been associated with the improvement of intraoperative and postoperative results. Due to the satisfying results and increasing experience and confidence with the robotic technique, surgeons are consequently enlarging the surgical indication, moving to increasingly challenging cases. Thoracic robotic surgery is being affirmed as a safe technique also for those complex cases, which in the past were considered a matter solely for open surgery. In fact, robotic surgery is increasingly associated with positive surgical results and guarantees less traumatism and a fast recovery to the patients. These positive results have resulted from the evolution of the technique, which has developed in parallel with the evolution of the technology, exploiting to its best the latest features of the robotic system. These features, such as the fluorescence-detection tool or the robotic stapler, have been aiding the surgeon to maximise the safety and feasibility of the application of the robotic technique to thoracic surgery.
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Affiliation(s)
- Carmelina C Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Teresa Hung Key
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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19
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Shahbazi M, Atashzar SF, Ward C, Talebi HA, Patel RV. Multimodal Sensorimotor Integration for Expert-in-the-Loop Telerobotic Surgical Training. IEEE T ROBOT 2018. [DOI: 10.1109/tro.2018.2861916] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Khan JS, Banerjee AK, Kim SH, Rockall TA, Jayne DG. Robotic rectal surgery has advantages over laparoscopic surgery in selected patients and centres. Colorectal Dis 2018; 20:845-853. [PMID: 30101574 DOI: 10.1111/codi.14367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Affiliation(s)
- J S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - A K Banerjee
- Department of Colorectal Surgery, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - S-H Kim
- Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - T A Rockall
- Minimal Access Therapy Training Unit (MATTU), Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - D G Jayne
- The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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21
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Bolger JC, Broe MP, Zarog MA, Looney A, McKevitt K, Walsh D, Giri S, Peirce C, Coffey JC. Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery. Tech Coloproctol 2017; 21:721-727. [PMID: 28929257 DOI: 10.1007/s10151-017-1687-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/18/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Minimally invasive surgery is associated with several patient-related benefits, including reduced length of hospital stay and reduced blood loss. Robotic-assisted surgery offers many advantages when compared with standard laparoscopic procedures, including a stable three-dimensional binocular camera platform, motion smoothing and motion scaling, improved dexterity and ergonomics. There are limited data on the effectiveness of the dual-console DaVinci Xi platform for teaching resident surgeons. The goal of this study was to examine preliminary outcomes following the introduction of a dual-console robotic platform in our institution. METHODS A retrospective review of our prospectively maintained patient database was performed. The first ten dual-console resident-performed procedures in colorectal surgery were compared with matched cases performed on a single console by the trainer. Patient demographics, operative times and patient outcomes were compared. RESULTS Twenty patients were included in this study. There was no significant difference in console time (p = 0.46) or total operative time (p = 0.52) when residents and trainers were compared. Patient outcomes were equivalent, with no difference in length of stay, morbidity or mortality. CONCLUSIONS The DaVinci Xi dual-console platform is a safe and effective platform for training junior surgeons. The dual-console system has the potential to alter surgical training pathways.
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Affiliation(s)
- J C Bolger
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - M P Broe
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - M A Zarog
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - A Looney
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - K McKevitt
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Walsh
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - S Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - C Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Abstract
PURPOSE OF REVIEW There has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks was conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon. RECENT FINDINGS A structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of basic robotic skills in the dry and wet lab setting along with achievement of individual and team-based non-technical skills, modular console training under supervision, and finally independent practice. Robotic surgical training must be based on demonstration of proficiency and safety in executing basic robotic skills and procedural tasks prior to independent practice.
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Affiliation(s)
- Ashwin N. Sridhar
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Tim P. Briggs
- Department of Urology, University College London Hospital NHS Trust, London, UK
| | - John D. Kelly
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Senthil Nathan
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
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Chammas J, Sauer A, Pizzuto J, Pouthier F, Gaucher D, Marescaux J, Mutter D, Bourcier T. Da Vinci Xi Robot-Assisted Penetrating Keratoplasty. Transl Vis Sci Technol 2017; 6:21. [PMID: 28660096 PMCID: PMC5482186 DOI: 10.1167/tvst.6.3.21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/30/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. METHODS Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). RESULTS Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. CONCLUSIONS We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. TRANSLATIONAL RELEVANCE Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
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Affiliation(s)
- Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Joëlle Pizzuto
- Cornea Bank, EFS Bourgogne Franche-Comté, Besancon, France
| | | | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Didier Mutter
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France
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Mitsinikos E, Abdelsayed GA, Bider Z, Kilday PS, Elliott PA, Banapour P, Chien GW. Does the Level of Assistant Experience Impact Operative Outcomes for Robot-Assisted Partial Nephrectomy? J Endourol 2016; 31:38-42. [PMID: 27806631 DOI: 10.1089/end.2016.0508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE A skilled assistant surgeon is presumed necessary during robot-assisted partial nephrectomy (RAPN) to minimize warm ischemia time (WIT) and to facilitate complex renorrhaphy. Studies observing impact of resident participation have focused on robotic prostatectomies, showing no impact on core surgical outcomes. Herein, we evaluated the level of experience of the bedside assistant and its impact on perioperative outcomes in RAPN. MATERIALS AND METHODS All RAPN cases in our healthcare system from January 2011 to December 2013 were retrospectively reviewed. The cases were divided into teaching and nonteaching hospitals. There were 18 fellowship-trained attending surgeons. At teaching hospitals, surgeries were performed by an attending physician and postgraduate year (PGY)-2 or PGY-3 resident at bedside; at nonteaching hospitals, surgeries were performed by two attending surgeons. We compared age, gender, body mass index, Charlson comorbidity index, operative difficulty by R.E.N.A.L. nephrometry score, and operative outcomes (WIT, estimated blood loss, operative time (OT), positive margin rate, length of stay (LOS), postoperative glomerular filtration rate, and readmission rate). RESULTS Of the 170 patients captured, 162 had R.E.N.A.L. nephrometry score and WIT: 112 from teaching hospitals and 50 from nonteaching hospitals. Patient characteristics were equivalent between both cohorts with the exception of the R.E.N.A.L. score, which was higher (6.3 vs 5.7, p = 0.046) in the teaching hospitals cohort. Regarding operative outcomes, we noted an overall increase in LOS by 1 day (p = 0.001) and OT by 16 minutes (p = 0.011) in the teaching hospitals. CONCLUSION We observed that increased LOS was the only clinically relevant measure negatively impacted by resident physician involvement during RAPN.
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Affiliation(s)
- Emmanuel Mitsinikos
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - George A Abdelsayed
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Zoe Bider
- 2 Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Patrick S Kilday
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Peter A Elliott
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Pooya Banapour
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Gary W Chien
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
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Santok GD, Raheem AA, Kim LH, Chang K, Chung BH, Choi YD, Rha KH. Proctorship and mentoring: Its backbone and application in robotic surgery. Investig Clin Urol 2016; 57:S114-S120. [PMID: 27995215 PMCID: PMC5161014 DOI: 10.4111/icu.2016.57.s2.s114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022] Open
Abstract
In pursuit of continuing medical education in robotic surgery, several forms of training have been implemented. This variable application of curriculum has brought acquisition of skills in a heterogeneous and unstandardized fashion from different parts of the world. Recently, efforts have been made to provide cost effective and well-structured curricula with the aim of bridging the gap between formal fellowship training and short courses. Proctorship training has been implicated on some curriculum to provide excellent progression during the learning curve while ensuring patient safety.
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Affiliation(s)
- Glen Denmer Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.; Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Lawrence Hc Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kidon Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.
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Affiliation(s)
- Allison Weaver
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott Steele
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
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Jarc AM, Stanley AA, Clifford T, Gill IS, Hung AJ. Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study. World J Urol 2016; 35:957-965. [PMID: 27671899 PMCID: PMC5486541 DOI: 10.1007/s00345-016-1944-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose In this study, we examine three-dimensional (3D) proctoring tools (i.e., semitransparent ghost tools overlaid on the surgeon’s field of view) on realistic surgical tasks. Additionally, we develop novel, quantitative measures of whether proctors exploit the additional capabilities offered by ghost tools. Methods Seven proctor–trainee pairs completed realistic surgical tasks such as tissue dissection and suturing in a live porcine model using 3D ghost tools on the da Vinci Xi Surgical System. The usability and effectiveness of 3D ghost tools were evaluated using objective measures of proctor performance based on proctor hand movements and button presses, as well as post-study questionnaires. Results Proctors exploited the capabilities of ghost tools, such as 3D hand movement (p < 0.001), wristedness (p < 0.001), finger pinch gestures (p < 0.001), and bimanual hand motions (p < 0.001). The median ghost tool excursion distances across proctors in the x-, y-, and z-directions were 57.6, 31.9, and 50.7, respectively. Proctors and trainees consistently evaluated the ghost tools as effective across multiple categories of mentoring. Trainees found ghost tools more helpful than proctors across all categories (p < 0.05). Conclusions Proctors exploit the augmented capabilities of 3D ghost tools during clinical-like training scenarios. Additionally, both proctors and trainees evaluated ghost tools as effective mentoring tools, thereby confirming previous studies on simple, inanimate tasks. Based on this preliminary work, advanced mentoring technologies, such as 3D ghost tools, stand to improve current telementoring and training technologies in robot-assisted minimally invasive surgery. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1944-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Thomas Clifford
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew J Hung
- Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Phé V, Cattarino S, Parra J, Bitker MO, Ambrogi V, Vaessen C, Rouprêt M. Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Véronique Phé
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Susanna Cattarino
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Jérôme Parra
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Marc-Olivier Bitker
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Vanina Ambrogi
- Pitié-Salpêtrière Academic Hospital, Department of Statistics, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Christophe Vaessen
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Morgan Rouprêt
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
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Crusco S, Jackson T, Advincula A. Comparing the da Vinci si single console and dual console in teaching novice surgeons suturing techniques. JSLS 2016; 18:JSLS-D-13-00218. [PMID: 25392618 PMCID: PMC4154408 DOI: 10.4293/jsls-d-13-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted laparoscopic surgery is often taught with the surgical mentor at the surgeon console and the trainee at the patient's bedside. The da Vinci dual console (Intuitive Surgical, Sunnyvale, California) allows a surgical mentor to teach with both the mentor and the trainee working at a surgeon console simultaneously. The purpose of this study is to evaluate the effectiveness of the dual console versus the single console for teaching medical students robotic tasks. METHODS Forty novice medical students were randomized to either the da Vinci single-console or dual-console group and were taught 4 knot-tying techniques by a surgical mentor. The students were timed while performing the tasks. RESULTS No statistically significant differences in mean task times were observed between the single- and dual-console groups: interrupted stitch with a 2-handed knot (300 seconds for single vs 294 seconds for dual, P=.59), interrupted stitch with a 1-handed knot (198 seconds for single vs 212 seconds for dual, P=.88), figure-of-8 stitch with a 2-handed knot (261 seconds for single vs 219 seconds for dual, P=.20), and figure-of-8 stitch with a 1-handed knot (200 seconds for single vs 199 seconds for dual, P=.53). CONCLUSION No significant difference was observed in performance time when teaching knot-tying techniques to medical students using the da Vinci dual console compared with the single console. More research needs to be performed on the utility of the da Vinci dual console in surgical training.
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Affiliation(s)
- Salvatore Crusco
- College of Medicine, University of Central Florida, Orlando, FL, USA
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Comparing Single and Dual Console Systems in the Robotic Surgical Training of Graduating OB/GYN Residents in the United States. Minim Invasive Surg 2016; 2016:5190152. [PMID: 26955485 PMCID: PMC4756193 DOI: 10.1155/2016/5190152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/22/2015] [Accepted: 01/10/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD) and residents (RES) towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4). Results. According to residents perception, dual console is utilized in about 70% of the respondents' programs. Dual console system programs were more likely to provide a robotics training certificate compared to single console programs (43.5% versus 0%, p = 0.03). A greater proportion of residents graduating from a dual console program perform more than 20 robotic-assisted total laparoscopic hysterectomies, 30% versus 0% (p = 0.15). Conclusions. Utilization of dual console system increased the likelihood of obtaining robotic training certification without significantly increasing the case volume of robotic-assisted total laparoscopic hysterectomy.
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Arlen AM, Kirsch AJ. Recent Developments in the Use of Robotic Technology in Pediatric Urology. Expert Rev Med Devices 2016; 13:171-8. [DOI: 10.1586/17434440.2016.1136211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Evaluation of a laparoscopic training program with or without robotic assistance. Eur J Obstet Gynecol Reprod Biol 2014; 181:321-7. [DOI: 10.1016/j.ejogrb.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/29/2014] [Accepted: 08/04/2014] [Indexed: 11/22/2022]
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IELPO B, VICENTE E, QUIJANO Y, DURAN H, DIAZ E, FABRA I, OLIVA C, OLIVARES S, CERÓN R, FERRI V, CARUSO R. An organizational model to improve the robotic system among general surgeons. G Chir 2014; 35:52-55. [PMID: 24690342 PMCID: PMC4321585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Robotic surgery has gained wide acceptance in recent years. However its development is slower and the lack of high level experience with this technique is an important limitation. This manuscript discusses some of the reasons of it and aims to describe the organizational system we have progressively established in our center in order to improve the development of Robotic program in our surgical area. METHODS Some points may be required to improve the robotic program development in a general surgical department, including: a broad availability of robotic system in a surgical area; an ideal setting area with mainly oncological and hepato-biliary-pancreatic disease; the need of a mainly young team; a broad application of the robotic system in more general surgical fields; a high motivation on robotic use; a departmental and institutional economical effort. We have tried to achieve these goals before starting the robotic program in our department at October 2010. RESULTS From October 2010 until November 2013 a total of 170 procedures have been performed, 92% of them for malignant diseases. Conversion rate and overall morbidity was 5% and 19%, respectively. CONCLUSIONS The organizational model defined in our center is facilitating the constant and progressive development of the robotic program. A broad and flexible availability of the robotic system, a progressive increase of young surgeons joining this technology as well as the institutional and departmental economical effort are the points with which the robotic system may increase its development in a surgical department.
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Affiliation(s)
- B. IELPO
- Corresponding author: Benedetto Ielpo, e-mail:
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