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Danys D, Marcinkeviciute K, Cereska V, Miknevicius P, Poskus T, Osorio J. Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Obes Surg 2024; 34:1983-1986. [PMID: 38530550 DOI: 10.1007/s11695-024-07200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.
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Affiliation(s)
- Donatas Danys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania.
| | | | - Vaidas Cereska
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Povilas Miknevicius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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2
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Tellez JC, Radi I, Alterio RE, Nagaraj MB, Baker HB, Scott DJ, Zeh HJ, Polanco PM. Proficiency Levels and Validity Evidence for Scoring Metrics for a Virtual Reality and Inanimate Robotic Surgery Simulation Curriculum. JOURNAL OF SURGICAL EDUCATION 2024; 81:589-596. [PMID: 38403503 DOI: 10.1016/j.jsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Our institution recently implemented a virtual reality (VR) skills curriculum for general surgery residents using the SimNow simulator. Based on a content alignment study, we revised the curriculum to include only 20 of 33 VR tasks and we added 3 previously validated inanimate tasks. The purpose of this study was to establish expert-derived proficiency levels for all tasks and to evaluate the validity of the scoring for the VR tasks. DESIGN Two expert robotic surgeons performed 5 repetitions of each VR and inanimate task. The trimmed mean (lowest scoring attempt and outliers [>2 standard deviations] were eliminated) was defined as the expert level for each task. For the VR tasks, expert levels were compared to resident performance to evaluate validity. SETTING This study was conducted at the University of Texas Southwestern Medical Center (Dallas, TX), a tertiary care academic teaching hospital. PARTICIPANTS Two expert robotic surgeons participated in this study. The data from 42 residents (PGY2-4) who completed the original curriculum was used to represent novice performance. RESULTS Comparison of expert levels and resident performance was statistically significant for 15 VR tasks (supporting validity) and approached significance (p = 0.06, 0.09) for 2 VR tasks; expert levels were designated as proficiency levels for these 17 tasks. Group comparisons were clearly not significant (p = 0.2-0.8) for 3 VR tasks; 2 of these 3 tasks were retained as introductory exercises (with 3 repetitions required) and 1 was excluded. For the 3 inanimate tasks, expert levels minus 2 standard deviations were designated as proficiency levels. CONCLUSIONS This analysis generated validity evidence for 15 VR tasks and established expert-derived proficiency levels for 17 VR tasks and 3 inanimate tasks. Our proposed curriculum now consists of 19 VR and 3 inanimate tasks using the selected proficiency levels. We anticipate that this design will maximize curriculum efficiency and effectiveness.
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Affiliation(s)
- Juan C Tellez
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imad Radi
- Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Rodrigo E Alterio
- Department of Surgery, Florida Atlantic University, Boca Raton, Florida
| | - Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haley B Baker
- Department of Otolaryngology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Pai SN, Jeyaraman M, Jeyaraman N, Nallakumarasamy A, Yadav S. In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus 2023; 15:e43634. [PMID: 37719624 PMCID: PMC10504870 DOI: 10.7759/cureus.43634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Hospital for Orthopedics, Sports Medicine, Arthritis, and Trauma (HOSMAT) Hospital, Bangalore, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Kiyasseh D, Laca J, Haque TF, Otiato M, Miles BJ, Wagner C, Donoho DA, Trinh QD, Anandkumar A, Hung AJ. Human visual explanations mitigate bias in AI-based assessment of surgeon skills. NPJ Digit Med 2023; 6:54. [PMID: 36997642 PMCID: PMC10063676 DOI: 10.1038/s41746-023-00766-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/21/2023] [Indexed: 04/03/2023] Open
Abstract
Artificial intelligence (AI) systems can now reliably assess surgeon skills through videos of intraoperative surgical activity. With such systems informing future high-stakes decisions such as whether to credential surgeons and grant them the privilege to operate on patients, it is critical that they treat all surgeons fairly. However, it remains an open question whether surgical AI systems exhibit bias against surgeon sub-cohorts, and, if so, whether such bias can be mitigated. Here, we examine and mitigate the bias exhibited by a family of surgical AI systems-SAIS-deployed on videos of robotic surgeries from three geographically-diverse hospitals (USA and EU). We show that SAIS exhibits an underskilling bias, erroneously downgrading surgical performance, and an overskilling bias, erroneously upgrading surgical performance, at different rates across surgeon sub-cohorts. To mitigate such bias, we leverage a strategy -TWIX-which teaches an AI system to provide a visual explanation for its skill assessment that otherwise would have been provided by human experts. We show that whereas baseline strategies inconsistently mitigate algorithmic bias, TWIX can effectively mitigate the underskilling and overskilling bias while simultaneously improving the performance of these AI systems across hospitals. We discovered that these findings carry over to the training environment where we assess medical students' skills today. Our study is a critical prerequisite to the eventual implementation of AI-augmented global surgeon credentialing programs, ensuring that all surgeons are treated fairly.
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Affiliation(s)
- Dani Kiyasseh
- Department of Computing and Mathematical Sciences, California Institute of Technology, California, CA, USA.
| | - Jasper Laca
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, California, CA, USA
| | - Taseen F Haque
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, California, CA, USA
| | - Maxwell Otiato
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, California, CA, USA
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Texas, TX, USA
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Daniel A Donoho
- Division of Neurosurgery, Center for Neuroscience, Children's National Hospital, Washington DC, WA, USA
| | - Quoc-Dien Trinh
- Center for Surgery & Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Animashree Anandkumar
- Department of Computing and Mathematical Sciences, California Institute of Technology, California, CA, USA
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, California, CA, USA.
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Information and Guidance on the Adoption of Surgical Innovation and Technology in Urogynecology. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:318-326. [PMID: 36808927 DOI: 10.1097/spv.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT The development of new technology and techniques (NTT) is an integral component of contemporary medicine. In surgery, rapidly advancing technology offers opportunities to innovate and study new approaches to help improve the quality and effectiveness of therapies. The American Urogynecologic Society is committed to the responsible implementation and use of NTT prior to the broad application of clinical care for patients, which includes not just new devices but application of new procedures. The aim of this document is to present a framework by which AUGS and its members can address future NTT development. Core areas of patient advocacy, industry partnerships, postmarket surveillance, and credentialing were identified to provide both a perspective and pathway for responsible use of NTT.
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Anderson DJ, Cao DY, Zhou J, McDonald M, Razzak AN, Hasoon J, Viswanath O, Kaye AD, Urits I. Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better? Health Psychol Res 2022; 10:38243. [PMID: 36118983 PMCID: PMC9476236 DOI: 10.52965/001c.38243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Urologic procedures (both open and minimally invasive) can cause pain due to the surgery itself, devices placed, and post-operative issues. Thus, pain management is important for every post-procedure recovery period. Opioid use post-surgery is common and often over-prescribed contributing to persistent use by patients. In this article, we review the extent of opioid use in pediatric urologic procedures, vasectomy, endourologic procedures, penile implantation, urogynecologic procedures, prostatectomy, nephrectomy, cystectomy, and scrotal/testicular cancer surgery. Generally, we have found that institutions do not have a standardized protocol with a set regimen to prescribe opioids, resulting in more opioids being prescribed than needed and patients not properly disposing of their unused prescriptions. However, many institutions recognize their opioid overuse and are implementing new multimodal opioid-sparing analgesics methods such as non-opioid peri-operative medications, minimally invasive robotic surgery, and nerve blocks or local anesthetics with varying degrees of success. By shedding light on these opioid-free methods and prescription protocols, along with improved patient education and counselling, we hope to bring awareness to institutions and decrease unnecessary opioid use.
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Affiliation(s)
| | - David Y Cao
- School of Medicine, Medical College of Wisconsin
| | - Jessica Zhou
- School of Medicine, Medical College of Wisconsin
| | - Matthew McDonald
- School of Medicine, Rocky Vista University College of Osteopathic Medicine
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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8
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Blackham R, Hamdorf J. Critical aspects in developing curriculum-based assessment for emerging surgical procedures. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:264-266. [PMID: 34942600 PMCID: PMC8995009 DOI: 10.5116/ijme.61ba.07c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
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Artsen AM, S Burkett L, Duvvuri U, Bonidie M. Surgeon satisfaction and outcomes of tele-proctoring for robotic gynecologic surgery. J Robot Surg 2021; 16:563-568. [PMID: 34272656 PMCID: PMC8284683 DOI: 10.1007/s11701-021-01280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
Surgical proctoring requires increasing resources in growing healthcare systems. In addition, travel has become less safe in the era of COVID-19. This study demonstrates surgeon satisfaction and safety with tele-proctoring in robotic gynecologic surgery. This pilot study assesses surgeon satisfaction and operative outcomes with a novel operative tele-proctoring system with a continuous two-way video-audio feed that allows the off-site surgeon to see the operating room, surgical field, and hands of the robotic surgeon. After thorough system testing, two experienced surgeons underwent tele-proctoring for hospital credentialing, completing 7 total cases. Each completed pre- and post-surveys developed from the Michigan Standard Simulation Experience Scale. Surgical characteristics were compared between tele-proctored cases and 59 historical cases proctored in-person over the last 8 years. Surgeons reported unanimous high satisfaction with tele-proctoring (5 ± 0). There were no major technologic issues. Five of the tele-proctored cases and 35 of controls were hysterectomies. Mean age was 48.2 ± 1.4 years, mean BMI was 29.6 ± 0.9 kg/m2, and mean uterine weight was 152 ± 112.3 g. Two-thirds had prior abdominal surgery (P > 0.1). Tele-proctored hysterectomies were 58 ± 6.5 min shorter than controls (P = 0.001). There were no differences in EBL or complication rates (P > 0.1). Tele-proctoring resulted in high surgeon satisfaction rates with no difference in EBL or complications. Tele-mentoring is a natural extension of tele-proctoring that could provide advanced surgical expertise far beyond where we can physically reach.
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Affiliation(s)
- Amanda M Artsen
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA.
| | - Linda S Burkett
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, PA, USA
| | - Michael Bonidie
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA, 15213, USA
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Sehmbi AS, Sridhar AN, Sahadevan K, Rai BP, Nwangwu P, Mohammed A, Freeman A, Mottrie A, Olsson MJ, Wiklund NP, Nathan MS, Briggs TP, Kelly JD, Rajan P. Early outcomes of robot-assisted radical prostatectomy following completion of a structured training curriculum: a single surgeon cohort study. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820938176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Technical skills in robot-assisted radical prostatectomy (RARP) are not mandated by the Intercollegiate Surgical Curriculum Programme. The European Association of Urology Robotic Urology Section (ERUS) developed a structured curriculum; however, surgeons’ outcomes data from subsequent independent practice are limited. We describe the initial post-ERUS curriculum RARP outcomes for a United Kingdom (UK)-based surgeon. Patients and methods: This was a prospective single surgeon cohort study of 272 patients who underwent RARP between February 2016 and October 2019 in a high-volume UK centre and who were followed up at approximately 3 and 12 months. Positive surgical margins (PSMs), and 3- and 12-month continence rates were obtained and used to generate learning curves, with point of plateau estimated from logarithmic trendlines. Results: Overall (⩾3 mm) PSM rate for pT2 was 14.9% (5.4%) and pT3 was 22.6% (3.2%). Where data were available, 70.5% (of n=251) and 95.5% (of n=154) patients achieved social continence (0–1 pads) at 3 and 12 months, respectively. PSM and 3-month social continence rates plateaued at ~175 and ~100 cases, respectively. Conclusion: Following completion of the ERUS RARP curriculum, early oncological and functional outcomes consistent with published standards are rapidly achievable in independent practice. These data exemplify the potential value of a standardised RARP training curriculum to mitigate possible compromises in outcomes. Level of evidence: IV
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Affiliation(s)
- Arjan S Sehmbi
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Cancer Research UK Barts Centre, Queen Mary University of London, UK
| | - Ashwin N Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
| | | | - Bhavan P Rai
- Department of Urology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK
| | - Pamela Nwangwu
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
| | - Anna Mohammed
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, UK
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Division of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Mats J Olsson
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
| | - N Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - M Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
| | - Timothy P Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
| | - John D Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
- Division of Surgery and Interventional Sciences, University College London, UK
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Cancer Research UK Barts Centre, Queen Mary University of London, UK
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, UK
- Department of Urology, Barts Health NHS Trust, London, UK
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Klompmaker S, van der Vliet WJ, Thoolen SJ, Ore AS, Verkoulen K, Solis-Velasco M, Canacari EG, Kruskal JB, Khwaja KO, Tseng JF, Callery MP, Kent TS, Moser AJ. Procedure-specific Training for Robot-assisted Distal Pancreatectomy. Ann Surg 2021; 274:e18-e27. [PMID: 30946088 DOI: 10.1097/sla.0000000000003291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. BACKGROUND RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. METHODS A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only; June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensity-score-matched (1:1) analysis to determine clinical efficacy. RESULTS After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P<0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (-1 day, P < 0.001). All other outcomes remained similar (P>0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31-65), and a steady-state (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. CONCLUSION Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.
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Affiliation(s)
- Sjors Klompmaker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Walderik J van der Vliet
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
- Department of Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Stijn J Thoolen
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
| | - Ana Sofia Ore
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
| | - Koen Verkoulen
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
- Department of Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Monica Solis-Velasco
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
| | - Elena G Canacari
- Department of Nursing, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan B Kruskal
- Medical Executive Committee, Beth Israel Deaconess Medical Center, Boston, MA
| | - Khalid O Khwaja
- The Transplant Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University, Boston, MA
| | - Mark P Callery
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
| | - Tara S Kent
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
| | - A James Moser
- Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA
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Grimaud LW, Chen FV, Chang J, Ziogas A, Sfakianos J, Badani KK, Uchio E, Anton-Culver H, Gin G. Comparison of Perioperative Outcomes for Radical Nephrectomy Based on Surgical Approach for Masses Greater than 10cm. J Endourol 2021; 35:1785-1792. [PMID: 34148404 DOI: 10.1089/end.2020.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective Robotic-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. Results A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared to ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p<0.0001) and LRN (-1.40 days ±0.12; p<0.0001) compared to ORN. LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. Conclusions Minimally invasive approaches are increasingly utilized in very large renal masses. RRN has lower rates of conversion to open but produces comparable perioperative outcomes to LRN. Minimally invasive approaches have a shorter length of inpatient stay but otherwise report similar surgical margin status, readmission rates, and mortality rates compared to open radical nephrectomy.
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Affiliation(s)
- Logan Wilson Grimaud
- University of California Irvine, 8788, Urology, 101 The City Drive South, Orange, California, United States, 92868;
| | - Felix V Chen
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jenny Chang
- University of California Irvine, 8788, Medicine, 301 Med Surge II, Irvine, California, United States, 92697;
| | - Argyrios Ziogas
- University of California Irvine School of Medicine, 12219, Medicine, Irvine, California, United States;
| | - John Sfakianos
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - Edward Uchio
- UCI Health, 14447, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868-3201;
| | - Hoda Anton-Culver
- University of California Irvine School of Medicine, 12219, Medicine , Irvine, California, United States;
| | - Greg Gin
- UCI, 8788, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,VA Medical Center Long Beach, 19974, Long Beach, California, United States, 90822-5201;
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13
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Chowdhury A, Tan LGL, Chiong E, Rha KH, Tiong HY. Transitioning to robotic partial nephrectomy with a team-based proctorship achieves the desired improved outcomes over open and laparoscopic partial nephrectomy. Updates Surg 2021; 73:1189-1196. [PMID: 33891279 DOI: 10.1007/s13304-021-01028-0] [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: 10/26/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Proctoring may facilitate a safe transition to robotic-assisted partial nephrectomy (RAPN) for centres performing open (OPN) and laparoscopic partial nephrectomies (LPN). This study compared the 5-year outcomes of RAPN, initiated with a team-based proctorship, with OPN and LPN. Following an observation course at the proctor's institution and a 3-surgeon performance of proctored RAPN in August 2014, a review of 90 RAPN, 29 LPN and 43 OPN consecutively performed by the same team from 2013 to 2019 at National University Hospital, Singapore was conducted. Peri-operative data, functional and oncological outcomes were compared amongst the three groups. Most cases were performed robotically after 2015 with comparable baseline characteristics in all groups. Median RENAL Nephrometry Score was not significantly different between RAPN (8 [IQR 6, 9]) and OPN (9 [IQR 7, 10]) (P = 0.12) but was significantly lower for LPN (7 [IQR 5, 8]) compared to RAPN (P = 0.002). RAPN achieved the lowest blood loss (226 ml vs.348 ml and 263 ml for OPN and LPN respectively, P = 0.02), transfusion rate (3% vs.21% and 17% respectively, P = 0.003) and median length of stay after surgery (4 vs.6 and 5 days respectively, P = 0.001). Complication rates, warm ischemic times were similar between the three approaches with no differences in 1-year and long-term renal function. The rate of positive surgical margin was 8%, 8% and 3% for RAPN, LPN and OPN, respectively (P = 0.76), with a single recurrence in each arm. Despite modest hospital volume, a team-based proctorship facilitated the transition to the Da Vinci robotic platform to perform partial nephrectomies of equivalent complexities as open surgery, achieving improved perioperative outcomes, while maintaining oncological and kidney functional results.
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Affiliation(s)
- Asrif Chowdhury
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Severance Hospital, Yongsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore.
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14
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Lima DL, Lima RNCL, Parra-Davila E, Morales-Conde S, Malcher F. Hernia U: challenges and opportunities of an online platform for surgical education. Rev Col Bras Cir 2021; 48:e20202873. [PMID: 33978136 PMCID: PMC10683420 DOI: 10.1590/0100-6991e-20202873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Diego Laurentino Lima
- - Montefiore Medical Center, Department of Surgery - The Bronx - NY - Estados Unidos
| | | | - Eduardo Parra-Davila
- - Good Samaritan Medical Center-TENET Health, Hernia and Abdominal Wall Reconstruction - West Palm Beach - FL - Estados Unidos
| | - Salvador Morales-Conde
- - Hospital Quironsalud Sagrado Corazon, General and Digestive Surgery Unit - Sevilla - Sevilla - Espanha
| | - Flavio Malcher
- - Montefiore Medical Center, Director Abdominal Wall Program, Department of Surgery - The Bronx - NY - Estados Unidos
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15
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Zahid A, Miskovic D. Proctorship in Minimally Invasive Colorectal Surgery. Clin Colon Rectal Surg 2021; 34:186-193. [PMID: 33815001 DOI: 10.1055/s-0040-1722765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Teaching an established surgeon in a novel technique by a colleague who has acquired a level of expertise is often referred to as "proctoring" or "precepting." Surgical preceptorships can be defined as supervised teaching programs, whereby individual or groups of surgeons (proctors) experienced in a certain technique support a colleague who wants to adopt this technique (sometimes referred to as "delegates" or "preceptees"). Preceptorship programs really focus on a specific technique, technology, or skill which is required to broaden, complement, or transform an established surgeon's practice. Within colorectal surgery, in the past 30 years, there is been an evolution of interventional options including open, laparoscopic, robotic, and endoscopic procedures. With each new emerging technology and technique, safe and effective uptake by established surgeons is best been attained by a period of proctorship by an experienced colleague. Formalizing this has been facilitated largely through industry support. There, however, remains a considerable chasm when it comes to standardization, quality control, and jurisprudence. This article aims to describe the requirements for a contemporary proctorship program, to examine instruments of quality control, and how to improve effectiveness.
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Affiliation(s)
- Assad Zahid
- St Mark's Hospital, London, United Kingdom.,University of Sydney, Australia
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16
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Waters PS, Flynn J, Larach JT, Fernando D, Peacock O, Foster JD, Flood M, McCormick JJ, Warrier SK, Heriot AG. Fellowship training in robotic colorectal surgery within the current hospital setting: an achievable goal? ANZ J Surg 2021; 91:2337-2344. [PMID: 33719148 DOI: 10.1111/ans.16677] [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] [Received: 09/22/2020] [Revised: 01/24/2021] [Accepted: 02/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although currently limited, the requirement for colorectal trainees to attain skills in robotic surgery is likely to increase due to further utilization of robotic platforms globally. The aim of the study is to describe the training programme utilized and assess outcomes of fellowship training in robotic colorectal surgery. METHODS A structured robotic training programme was generated across a tertiary hospital setting. Review of four prospectively maintained fellow operative logbooks was performed to assess caseload and skill acquisition. Operative and patient-related outcomes were compared with consultant trainer performed cases. Data were analysed using R with a P < 0.05 considered significant. RESULTS The structured robotic training scheme is a two-tiered system over a 12-month period. The trainer-directed pathway comprised of a robotic console safety course followed by cart-side assisting, a wet lab animal course, dual-console accreditation training course and onsite proctoring, prior to becoming an independent console surgeon. Over 2 years, 265 robotic (n = 143 primary/component surgeon) cases were undertaken with fellows A, B, C and D involved in 63, 77, 75 and 50 robotic colorectal cases, respectively. Individual learning curves revealed independent procedure competency at cases 11, 14, 15 and 12, respectively, for robotic anterior resection. There was no significant difference observed in operative time (P = 0.39), blood loss (P = 0.41), lymph node harvest (P = 0.35), conversion rates (2% versus 4%), anastomotic leaks (1% versus 3%) and R0 resection rates (100% versus 98% colonic, 96% versus 96% rectal, P = 0.48) between surgical fellows and consultant trainers. Clavien-Dindo(III-IV) complications were similar (10% versus 6%,P = 0.25) with no mortalities encountered. CONCLUSION It is feasible and safe to train fellows in robotic colorectal surgery without compromise of operative- and patient-related outcomes.
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Affiliation(s)
- Peadar S Waters
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julie Flynn
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth Hospital, Melbourne, Victoria, Australia
| | - Jose T Larach
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth Hospital, Melbourne, Victoria, Australia.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diharah Fernando
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Oliver Peacock
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jake D Foster
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Flood
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth Hospital, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth Hospital, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth Hospital, Melbourne, Victoria, Australia
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17
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Larach JT, Flynn J, Kong J, Waters PS, McCormick JJ, Murphy D, Stevenson A, Warrier SK, Heriot AG. Robotic colorectal surgery in Australia: evolution over a decade. ANZ J Surg 2021; 91:2330-2336. [PMID: 33438361 DOI: 10.1111/ans.16554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years. METHODS Data from patients undergoing robotic colorectal surgery with the da Vinci robotic platform between 2010 and 2019 were obtained. Overall, numbers of specific colorectal procedures across Australia were obtained from the Medicare Benefit Schedule data over the same period. Pearson's correlation analysis was used to determine the statistical trends of overall and specific robotic colorectal procedures over time. RESULTS A total of 6110 robotic general surgery procedures were performed across Australia during the study period. Of these, 3522 (57.6%) were robotic colorectal procedures. An increasing trend of overall robotic colorectal procedures was seen over 10 years (Pearson's coefficient of 0.875; P = 0.001). While this applied to both the public and private sectors, 90.7% of the procedures were undertaken in the private sector. Restorative rectal resections, rectopexies, and right hemicolectomies accounted for 82.6% of the robotic colorectal procedures performed during this period with an increasing trend seen over time for each intervention. Moreover, a robotic approach was utilized in 12.5%, 41.0% and 9.0% of all restorative rectal resections, rectopexies and right hemicolectomies undertaken in Australia during 2019, respectively. CONCLUSION Robotic colorectal surgery has increased dramatically in Australia over the last 10 years, especially in the private sector. Penetration of robotic colorectal surgery in the public healthcare system will require focussed cost-benefit evaluations and governmental investment.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peadar S Waters
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Andrew Stevenson
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
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18
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Yu N, Saadat H, Finelli A, Lee JY, Singal RK, Grantcharov TP, Goldenberg MG. Quantifying the "Assistant Effect" in Robotic-Assisted Radical Prostatectomy (RARP): Measures of Technical Performance. J Surg Res 2020; 260:307-314. [PMID: 33370599 DOI: 10.1016/j.jss.2020.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/12/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Surgeons are reliant on the bedside assistant during robotic surgeries. Using a modified global rating scale (GRS), we aim to assess the association between an assistant's technical skill on surgeon performance in Robotic-Assisted Radical Prostatectomy (RARP). METHODS Prospective, intraoperative video from RARP cases at three centers were collected. Baseline demographic and RARP-experience data were collected from participating surgeons and trainees. The dissection of the prostatic pedicle and neurovascular bundle step (NVB) was analyzed. Expert analysts scored the console surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS), and the bedside assistant performance using a modified Objective Structured Assessment of Technical Skills (aOSATS). The primary outcome is the association between console surgeon performance, as measured by GEARS, and assistant skill, as measured by aOSATS. Spearman's rho correlations were used to test the relationship between assistant and surgeon technical performance, and a multivariable linear regression model was created to test this association while controlling for patient factors. RESULTS 92 RARP cases were available for the analysis, comprising 14 console surgeons and 22 different bedside assistants. In only 5 (5.4%) cases, the neurovascular bundle step was completed by a trainee, and in 13 (14.1%) of cases, a staff-level surgeon acted as the bedside assistant. aOSATS score was significantly associated with robotic console experience (P = 0.011), and prior laparoscopic experience (P < 0.001). Assistant aOSATS score showed a weak but significant correlation with surgeon GEARS score during the neurovascular bundle step (spearman's rho = 0.248, P = 0.028). On linear regression, aOSATS remained a significant predictor of console surgeon performance (P = 0.016), after controlling for patient age and BMI, prostate volume, tumor stage, and presence of nerve-sparing. CONCLUSIONS This is the first study to assess the association between assistant technical skill and surgeon performance in RARP. Additionally, we have provided validity evidence for a modified OSATS global rating scale for training and assessing bedside assistant performance.
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Affiliation(s)
- Nancy Yu
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Hossein Saadat
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Rajiv K Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; International Centre for Surgical Safety, St. Michael's Hospital, Toronto, Canada
| | - Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada; International Centre for Surgical Safety, St. Michael's Hospital, Toronto, Canada.
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19
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Eardley NJ, Matzel KE, Gómez Ruiz M, Khan JS, Riley SA, Donnelly MT, Tou S. European Society of Coloproctology Colorectal Robotic Surgery Training for the Trainers Course - the first pilot experience. Colorectal Dis 2020; 22:1741-1748. [PMID: 32663345 DOI: 10.1111/codi.15265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023]
Abstract
AIM Currently, there is no established colorectal specific robotic surgery Train the Trainer (TTT) course. The aim was to develop and evaluate such a course which can then be further developed to be incorporated within the planned European Society of Coloproctology (ESCP)/European School of Coloproctology (ESC) robotic colorectal surgery training curriculum. METHOD After identifying the need for such a course within a training programme, the course was developed by a subgroup of the ESCP/ESC. A scoping literature review was performed and the content and materials for the course were developed by a team consisting of two gastroenterologists with a combined experience of 30 years of facilitating TTT courses, a robotic surgeon and proctor with laparoscopic TTT faculty experience and experienced robotic and laparoscopic colorectal trainers. The course was evaluated by asking delegates to complete pre- and post-course questionnaires. RESULTS There were eight delegates on the course from across Europe. Delegates increased their knowledge of each of the course learning objectives and identified learning points in order to change practice. The feedback from the delegates of the course was positive across several areas and all felt that they had achieved their own personal objectives in attending the course. CONCLUSION This pilot robotic colorectal TTT course has achieved its aim and demonstrated many positives. There is a need for such a course and the evaluation processes have provided opportunities for reflection, which will allow the development/tailoring of future robotic colorectal TTT courses to help develop robotic training further.
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Affiliation(s)
- N J Eardley
- Department of Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - K E Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - M Gómez Ruiz
- Colorectal Surgery Unit, Department of Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J S Khan
- Department of Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - S A Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M T Donnelly
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Tou
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, UK
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Abstract
Summary
Background
In the surgical treatment of esophageal cancer, complete tumor resection is the most important factor and determines long-term survival. With an increase in robotic expertise in other fields of surgery, robotic-assisted minimally invasive esophagectomy (RAMIE) was born. Currently, there is a lack of convincing data on the extent of expected benefits (perioperative and oncologic outcomes and/or quality of life). Some evidence exists that patients’ overall quality of life and physical function improves, with less fatigue and pain 3 months after surgery. We aimed to review the available literature regarding robotic esophagectomy, compare perioperative, oncologic, and quality of life outcomes with open and minimally invasive approaches, and give a brief overview of our standardized four-arm RAMIE technique and explore future directions.
Methods
A Medline (PubMed) search was conducted including the following key words: esophagectomy, minimally invasive esophagectomy, robotic esophagectomy, Ivor Lewis and McKeown. We present the history, different techniques used, outcomes, and the standardization of robotic esophagectomy.
Results
Robotic esophagectomy offers a steeper learning curve with fewer complications but comparable oncological results compared to conventional minimally invasive esophagectomy.
Conclusions
Available studies suggest that RAMIE is associated with benefits regarding length of stay, clinical outcomes, and quality of life—if patients are treated in an experienced center with a standardized technique for robotic esophagectomy—making it a potentially beneficial tool in the treatment of esophageal cancer. However, center-wide standardization and prospective data collection will be a necessity to prove superiority of robotic esophagectomy.
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Leijte E, de Blaauw I, Rosman C, Botden SMBI. Assessment of validity evidence for the RobotiX robot assisted surgery simulator on advanced suturing tasks. BMC Surg 2020; 20:183. [PMID: 32787831 PMCID: PMC7430880 DOI: 10.1186/s12893-020-00839-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/30/2020] [Indexed: 01/24/2023] Open
Abstract
Background Robot assisted surgery has expanded considerably in the past years. Compared to conventional open or laparoscopic surgery, virtual reality (VR) training is an essential component in learning robot assisted surgery. However, for tasks to be implemented in a curriculum, the levels of validity should be studied for proficiency-based training. Therefore, this study was aimed to assess the validity evidence of advanced suturing tasks on a robot assisted VR simulator. Method Participants were voluntary recruited and divided in the robotic experienced, laparoscopic experienced or novice group, based on self-reported surgical experience. Subsequently, a questionnaire on a five-point Likert scale was completed to assess the content validity. Three component tasks of complex suturing were performed on the RobotiX simulator (Task1: tilted plane needle transfer, Task: 2 intracorporal suturing, Task 3: anastomosis needle transfer). Accordingly, the outcome of the parameters was used to assess construct validity between robotic experienced and novice participants. Composite scores (0–100) were calculated from the construct parameters and corresponding pass/fail scores with false positive (FP) and false negative (FN) percentages. Results Fifteen robotic experienced, 26 laparoscopic experienced and 29 novices were recruited. Overall content validity outcomes were scored positively on the realism (mean 3.7), didactic value (mean 4.0) and usability (mean 4.2). Robotic experienced participants significantly outperformed novices and laparoscopic experienced participants on multiple parameters on all three tasks of complex suturing. Parameters showing construct validity mainly consisted of movement parameters, needle precision and task completion time. Calculated composite pass/fail scores between robotic experienced and novice participants resulted for Task 1 in 73/100 (FP 21%, FN 5%), Task 2 in 85/100 (FP 28%, FN 4%) and Task 3 in 64/100 (FP 49%, FN 22%). Conclusion This study assessed the validity evidence on multiple levels of the three studied tasks. The participants score the RobotiX good on the content validity level. The composite pass/fail scores of Tasks 1 and 2 allow for proficiency-based training and could be implemented in a robot assisted surgery training curriculum.
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Affiliation(s)
- Erik Leijte
- Department of Surgery, Radboud University Medical Center, Geert grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands. .,Department of Pediatric Surgery, Radboud University Medical Center, Geert grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands.
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Center, Geert grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Geert grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboud University Medical Center, Geert grooteplein 10 route 618, 6500HB, Nijmegen, The Netherlands
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22
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Wang Z, Kasman M, Martinez M, Rege R, Zeh H, Scott D, Fey AM. A Comparative Human-Centric Analysis of Virtual Reality and Dry Lab Training Tasks on the da Vinci Surgical Platform. ACTA ACUST UNITED AC 2020. [DOI: 10.1142/s2424905x19420078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is a growing, widespread trend of adopting robot-assisted minimally invasive surgery (RMIS) in clinical care. Dry lab robot training and virtual reality simulation are commonly used to train surgical residents; however, it is unclear whether both types of training are equivalent or can be interchangeable and still achieve the same results in terms of training outcomes. In this paper, we take the first step in comparing the effects of physical and simulated surgical training tasks on human operator kinematics and physiological response to provide a richer understanding of exactly how the user interacts with the actual or simulated surgical robot. Four subjects, with expertise levels ranging from novice to expert surgeon, were recruited to perform three surgical tasks — Continuous Suture, Pick and Place, Tubes, with three repetitions — on two training platforms: (1) the da Vinci Si Skills Simulator and (2) da Vinci S robot, in a randomized order. We collected physiological response and kinematic movement data through body-worn sensors for a total of 72 individual experimental trials. A range of expertise was chosen for this experiment to wash out inherent differences based on expertise and only focus on inherent differences between the virtual reality and dry lab platforms. Our results show significant differences ([Formula: see text]-[Formula: see text]) between tasks done on the simulator and surgical robot. Specifically, robotic tasks resulted in significantly higher muscle activation and path length, and significantly lower economy of volume. The individual tasks also had significant differences in various kinematic and physiological metrics, leading to significant interaction effects between the task type and training platform. These results indicate that the presence of the robotic system may make surgical training tasks more difficult for the human operator. Thus, the potentially detrimental effects of virtual reality training alone are an important topic for future investigation.
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Affiliation(s)
- Ziheng Wang
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Michael Kasman
- Department of Electrical & Computer Engineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Marco Martinez
- Department of Surgery, Naval Medical Center, San Diego, CA 92134, USA
| | - Robert Rege
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Herbert Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Daniel Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, TX 75080, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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23
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Trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing, robot-assisted radical prostatectomy: a 10-year low-intermediate volume single-center experience. World J Urol 2020; 39:389-397. [PMID: 32328779 DOI: 10.1007/s00345-020-03206-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing (NS), robot-assisted radical prostatectomy (RARP) in a single low-intermediate volume prostate cancer (PCa) center over a 10-year period. MATERIALS AND METHODS We queried a prospectively maintained database for patients who underwent NS RARP between 2009 and 2018 in a low-intermediate volume PCa center. Risk-groups were defined according to the D'Amico classification. Pentafecta outcomes referred to the postsurgical presence of potency and continence, and the absence of biochemical recurrence (BCR), positive surgical margins (PSM), and perioperative complications. The Kruskall-Wallis test, the t test and the Mann-Whitney tests were used when appropriate. RESULTS 603 patients underwent NS RARP and 484 patients were evaluated for Pentafecta outcomes. Median postsurgical follow-up was 28 months. Overall, 137 (22.7%), 376 (62.3%), and 90 (15%) patients were diagnosed in the low-, intermediate-, and high-risk groups, respectively. Patients undergoing NS RARP shifted from 33 to 20% in the low-risk group, from 52 to 62% in the intermediate-risk group, and from 10 to 13% in the high-risk group. Patients reaching Pentafecta increased from 38 to 44%. No postoperative potency was the main reason for non-achieving Pentafecta (71%). BCR strongly limited Pentafecta achievement in the high-risk group (61%), but not in intermediate (24%) and low-risk (30%) groups. CONCLUSIONS Low-intermediate volume PCa centers show similar trends to high-volume centers regarding risk group distributions over time in PCa patients undergoing NS RARP. We reported an increase in Pentafecta outcomes achievement over time even for experienced surgeons. Pentafecta outcomes achievement is risk-group dependent.
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24
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Shkolyar E, Shih IF, Li Y, Wong JA, Liao JC. Robot-Assisted Radical Prostatectomy Associated with Decreased Persistent Postoperative Opioid Use. J Endourol 2020; 34:475-481. [PMID: 32066277 PMCID: PMC7194325 DOI: 10.1089/end.2019.0788] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Minimally invasive surgery offers reduced pain and opioid use postoperatively compared with open surgery, but large-scale comparative studies are lacking. We assessed the incidence of persistent opioid use after open and robot-assisted radical prostatectomy (RARP). Materials and Methods: We performed a retrospective claims database cohort study of opioid-naive (i.e., no opioid prescriptions 30–180 days before index surgery) adult males who underwent radical prostatectomy for prostate cancer from July 2013 to June 2017. For patients who filled a perioperative opioid prescription (30 days before to 14 days after surgery), we calculated the incidence of new persistent postoperative opioid use (≥1 prescription 90–180 days after surgery). Multivariable logistic regression was performed to investigate the association between the surgical approach, patient risk factors, and persistent opioid use. Results: Twelve thousand two hundred seventy-eight radical prostatectomy patients filled an opioid prescription perioperatively (1510 [12%] open and 10,768 [88%] robot assisted). Of these, 846 (6.9%) patients continued to fill opioid prescription(s) 90 to 180 days after surgery. Patients undergoing RARP were 35% less likely to develop new persistent opioid use compared with those undergoing open radical prostatectomy (6.5% vs 9.7%; adjusted odds ratio 0.65; 95% confidence interval 0.54, 0.79). Other independent risk factors included living in the southern, western, or north central United States; preoperative comorbidity; and tobacco use. Conclusions: Approximately 6.9% of opioid-naive patients continued to fill opioid prescriptions 90 days after radical prostatectomy. The risk of persistent opioid use was significantly lower among patients undergoing a robot-assisted vs open approach. Further efforts are needed to develop postoperative opioid prescription protocols for patients undergoing radical prostatectomy.
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Affiliation(s)
- Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - I-Fan Shih
- Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Yanli Li
- Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Jaime A Wong
- VA Palo Alto Health Care System, Palo Alto, California, USA.,Intuitive Surgical, Inc., Sunnyvale, California, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
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25
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Celentano V, Smart N, McGrath J, Cahill RA, Spinelli A, Challacombe B, Belyansky I, Hasegawa H, Munikrishnan V, Pellino G, Ahmed J, Muysoms F, Saklani A, Khan J, Popowich D, Ballecer C, Coleman MG. How to report educational videos in robotic surgery: an international multidisciplinary consensus statement. Updates Surg 2020; 73:815-821. [PMID: 32146699 PMCID: PMC8184705 DOI: 10.1007/s13304-020-00734-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022]
Abstract
The swift endorsement of the robotic surgical platform indicates that it might prevail as the preferred technique for many complex abdominal and pelvic operations. Nonetheless, use of the surgical robotic system introduces further layers of complexity into the operating theatre necessitating new training models. Instructive videos with relevant exposition could be optimal for early training in robotic surgery and the aim of this study was to develop consensus guidelines on how to report a robotic surgery video for educational purposes to achieve high quality educational video outputs that could enhance surgical training. A steering group prepared a Delphi survey of 46 statements, which was distributed and voted on utilising an electronic survey tool. The selection of committee members was designed to include representative surgical trainers worldwide across different specialties, including lower and upper gastrointestinal surgery, general surgery, gynaecology and urology. 36 consensus statements were approved and classified in seven categories: author’s information and video introduction, case presentation, demonstration of the surgical procedure, outcomes of the procedure, associated educational content, review of surgical videos quality and use of surgical videos in educational curricula. Consensus guidelines on how to report robotic surgery videos for educational purposes have been elaborated utilising Delphi methodology. We recommend that adherence to the guidelines presented could support advancing the educational quality of video outputs when designed for training.
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Affiliation(s)
- Valerio Celentano
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK. .,University of Portsmouth, Portsmouth, UK.
| | - Neil Smart
- Exeter Surgical Health Services, Research Unit, Royal Devon & Exeter Hospital, Exeter, Devon, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
| | - Ronan A Cahill
- Colorectal Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,Section of Surgery and Surgical Specialities, School of Medicine, University College Dublin, Dublin, Ireland
| | - Antonino Spinelli
- Humanitas Clinical and Research Center - IRCCS, 20089, via Manzoni 56, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 9RT, UK
| | - Igor Belyansky
- Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA
| | - Hirotoshi Hasegawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | | | - Gianluca Pellino
- Department of Medical, Surgical, Neurological, Metabolic, and Ageing Sciences, Universitá Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Jamil Ahmed
- Department of Colorectal Surgery, The Royal Bournemouth Hospital NHS Foundation Trust, Bournemouth, UK
| | - Filip Muysoms
- Departement of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Daniel Popowich
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Conrad Ballecer
- Center for Minimally Invasive and Robotic Surgery, Phoenix, AZ, USA
| | - Mark G Coleman
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
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26
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Vanlander AE, Mazzone E, Collins JW, Mottrie AM, Rogiers XM, van der Poel HG, Van Herzeele I, Satava RM, Gallagher AG. Orsi Consensus Meeting on European Robotic Training (OCERT): Results from the First Multispecialty Consensus Meeting on Training in Robot-assisted Surgery. Eur Urol 2020; 78:713-716. [PMID: 32089358 DOI: 10.1016/j.eururo.2020.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/05/2020] [Indexed: 01/22/2023]
Abstract
To improve patient outcomes in robotic surgery, robotic training and education need to be modernised and augmented. The skills and performance levels of trainees need to be objectively assessed before they operate on real patients. The main goal of the first Orsi Consensus Meeting on European Robotic Training (OCERT) was to establish the opinions of experts from different scientific societies on standardised robotic training pathways and training methodology. After a 2-d consensus conference, 36 experts identified 23 key statements allotted to three themes: training standardisation pathways, validation metrics, and implementation prerequisites and certification. After two rounds of Delphi voting, consensus was obtained for 22 of 23 questions among these three categories. Participants agreed that societies should drive and support the implementation of benchmarked training using validated proficiency-based pathways. All courses should deliver an internationally agreed curriculum with performance standards, be accredited by universities/professional societies, and, trainees should receive a certificate approved by professional societies and/or universities after successful completion of the robotic training courses. This OCERT meeting established a basis for bringing surgical robotic training out of the operating room by seeking input and consensus across surgical specialties for an objective, validated, and standardised training programme with transparent, metric-based training outcomes. PATIENT SUMMARY: The Orsi Consensus Meeting on European Robotic Training (OCERT) is an international, multidisciplinary, Delphi-panel study of scientific societies and experts focused on training in robotic surgery. The panel achieved consensus that standardised international training pathways should be the basis for a structured, validated, replicable, and certified approach to implementation of robotic technology.
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Affiliation(s)
- Aude E Vanlander
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Elio Mazzone
- Orsi Academy, Melle, Belgium; Department of Urology, OLV, Aalst, Belgium; Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Justin W Collins
- Orsi Academy, Melle, Belgium; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Xavier M Rogiers
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | | | - Anthony G Gallagher
- Orsi Academy, Melle, Belgium; Faculty of Life and Health Sciences, Ulster University, Belfast, Northern Ireland, UK
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27
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Abstract
The surgery practiced today is not the same as the surgery practiced a generation ago and because of the ever-evolving nature of medicine, ongoing education, and adoption of new technology is vital for all surgeons. New technology has the potential to revolutionize the way we practice medicine; however, it is important to understand the context in which new medical devices arise and to approach new medical devices with a healthy combination of skepticism and optimism. Surgeons should feel comfortable assessing, critiquing, and adopting new technology.
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28
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Akpinar C, Suer E, Turkolmez K, Beduk Y. Combined Robotic-assisted Laparoscopic Radical Prostatectomy and Partial Nephrectomy, Rare Coincidence. Urology 2019; 128:1-4. [DOI: 10.1016/j.urology.2019.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
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29
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Larcher A, De Naeyer G, Turri F, Dell'Oglio P, Capitanio U, Collins JW, Wiklund P, Van Der Poel H, Montorsi F, Mottrie A. The ERUS Curriculum for Robot-assisted Partial Nephrectomy: Structure Definition and Pilot Clinical Validation. Eur Urol 2019; 75:1023-1031. [PMID: 30979635 DOI: 10.1016/j.eururo.2019.02.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND No validated training program for robot-assisted partial nephrectomy (RAPN) exists. OBJECTIVE To define the structure and provide a pilot clinical validation of a curriculum for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS A modified Delphi consensus methodology involving 27 experts defined curriculum structure. One trainee completed the curriculum under the mentorship of an expert. A total of 40 patients treated with curriculum RAPN (cRAPN) were compared with 160 patients treated with standard of care (sRAPN). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To define curriculum structure, consensus was defined as ≥90% expert agreement. To investigate curriculum safety, perioperative morbidity, renal function, and pathologic outcomes were evaluated. To investigate curriculum efficacy, RAPN steps and modules attempted and completed by the trainee were evaluated. Propensity score matching identified comparable cRAPN and sRAPN cases. Mann-Whitney U test, chi-square test, and linear regression were used to investigate the impact of the curriculum on patient's outcome and the impact of trainee's experience on surgical independence. RESULTS AND LIMITATIONS Consensus-based key statements defined curriculum structure. No difference was recorded between cRAPN and sRAPN with respect to intraoperative or overall and grade-specific postoperative complications, blood loss, ischemia time, postoperative estimated glomerular filtration rate, and positive surgical margins (all p>0.05). Conversely, operative time was longer after cRAPN (p<0.0001). The trainee completed all phases of the curriculum and the trainee's experience was associated with more steps attempted/completed and increasing complexity of module attempted/completed (all p<0.0001). The limitations of the study are the enrolment of a single trainee at a single institution and the small sample size. Accordingly, the large confidence intervals observed cannot exclude inferior outcomes in case of cRAPN and further study is required to confirm safety. CONCLUSIONS The European Association of Urology (EAU) Robotic Urology Section (ERUS) curriculum for RAPN can protect patients from suboptimal outcome during the learning curve of the surgeon and can aid surgeons willing to start an RAPN program. PATIENT SUMMARY Patients should be aware that structured training programs can reduce the risk of suboptimal outcome due to the learning curve of the surgeon.
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Affiliation(s)
- Alessandro Larcher
- Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
| | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Filippo Turri
- ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Paolo Dell'Oglio
- Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Umberto Capitanio
- Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Justin W Collins
- ORSI Academy, Melle, Belgium; Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Francesco Montorsi
- Department of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
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30
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Rapoport LM, Bezrukov EA, Tsarichenko DG, Martirosyan GA, Sukhanov RB, Krupinov GE, Slusarenco RI, Morozov AO, Avakyan SK, Sargsyan NA. [Methods for training of robot-assisted radical prostatectomy]. Khirurgiia (Mosk) 2019:89-94. [PMID: 30789615 DOI: 10.17116/hirurgia201901189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.
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Affiliation(s)
- L M Rapoport
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Bezrukov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D G Tsarichenko
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G A Martirosyan
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R B Sukhanov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G E Krupinov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R I Slusarenco
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - A O Morozov
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S K Avakyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N A Sargsyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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31
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Bedir F, Keske M, Demirdöğen ŞO, Kocatürk H, Koç E, Canda AE, Atmaca AF. Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey. Turk J Urol 2019; 45:183-188. [PMID: 30817280 DOI: 10.5152/tud.2019.24444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. MATERIAL AND METHODS The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. RESULTS The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. CONCLUSION RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.
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Affiliation(s)
- Fevzi Bedir
- Department of Urology, University of Health Sciences, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Murat Keske
- Clinic of Urology, Kayseri City Hospital, Kayseri, Turkey
| | - Şaban Oğuz Demirdöğen
- Department of Urology, University of Health Sciences, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Hüseyin Kocatürk
- Department of Urology, University of Health Sciences, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Erdem Koç
- Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | | | - Ali Fuat Atmaca
- Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.,Department of Urology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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32
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Mukherjee P, Clark J, Wallace G, Cheng K, Solomon M, Richardson A, Maddern G. Discussion paper on proposed new regulatory changes on 3D technology: a surgical perspective. ANZ J Surg 2019; 89:117-121. [PMID: 30665261 DOI: 10.1111/ans.14946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/07/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Payal Mukherjee
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Gordon Wallace
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kai Cheng
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Arthur Richardson
- University of Sydney, Sydney, New South Wales, Australia.,Westmead Hospital, Sydney, New South Wales, Australia
| | - Guy Maddern
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Kwong JC, Lee JY, Goldenberg MG. Understanding and Assessing Nontechnical Skills in Robotic Urological Surgery: A Systematic Review and Synthesis of the Validity Evidence. JOURNAL OF SURGICAL EDUCATION 2019; 76:193-200. [PMID: 29958854 DOI: 10.1016/j.jsurg.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Robotic urological surgery (RUS) has seen widespread adoption across institutions in the last decade. To match this rapid growth, it is imperative to develop a structured RUS curriculum that addresses both technical and nontechnical competencies. Emerging evidence has shown that nontechnical skills form a critical component of RUS training. The purpose of this review is to examine the validity evidence of available nontechnical skills assessment tools in RUS. METHODS A literature search of MEDLINE, EMBASE, and PsycINFO was conducted to identify primary articles using nontechnical skills assessment tools in RUS. Messick's validity framework and the Medical Education Research Study Quality Instrument were utilized to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Of the 566 articles identified, 12 used nontechnical skills assessment tools in RUS. The metrics used ranged from self-assessment using global rating scales, to objective measures such as electroencephalography. The setting of these evaluations ranged from immersive and virtual reality-based simulators to live surgery. CONCLUSIONS Limited effort has been made to develop nontechnical skills assessment tools in RUS. Recently, there has been a shift from subjective to objective measures of nontechnical performance, as well as the development of assessments specific to RUS. However, the validity evidence supporting these nontechnical assessments is limited at this time, including their relationship to technical skills, and their impact on surgical outcomes.
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Affiliation(s)
- Jethro Cc Kwong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Moldes JM, de Badiola FI, Vagni RL, Mercado P, Tuchbaum V, Machado MG, López PJ. Pediatric Robotic Surgery in South America: Advantages and Difficulties in Program Implementation. Front Pediatr 2019; 7:94. [PMID: 30984719 PMCID: PMC6447650 DOI: 10.3389/fped.2019.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/04/2019] [Indexed: 11/21/2022] Open
Abstract
Robotic assisted laparoscopic surgery is gaining popularity around the world due to its vast benefits. Although it has been established mainly in developed countries, in South America the robotic programs have become more popular, but its growth is clearly slower. Information about robotic pediatric surgery program in Brazil, Chile, Uruguay, and Argentina was collected through e-mail surveys. Results were analyzed and compared to worldwide information about robotic surgery. Due to the wide social, economical, and technological gap between hospitals in South America, it is hard to develop a proper pediatric robotic surgery program. The main obstacles in those four countries appear to be a combination of high purchase costs and equipment maintenance, lack of financial coverage of the procedure by insurance companies and the absence of significant benefits proved in pediatrics in relation to laparoscopic surgery. The pediatric specialties are in the process of making and implementing robotic programs supported by the evident development in adult specialties. However, pediatric robotic surgery in Brazil, Chile, Uruguay and Argentina do not seems to share that growth.
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Affiliation(s)
- Juan M Moldes
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Roberto Luis Vagni
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Mercado
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Tuchbaum
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos G Machado
- Department of Urology, Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - Pedro José López
- Department Pediatric Urology, Hospital Exequiel Gonzalez Cortés y Clínica Alemana, Santiago, Chile
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Fritz MA, Postma GN. Where am I? Transnasal esophagoscopy outside the normal esophagus. EAR, NOSE & THROAT JOURNAL 2018; 96:E44. [PMID: 29236282 DOI: 10.1177/014556131709601210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Medical malpractice is costly and disruptive, and it is important to prevent. We conducted a study with the objective to look at medical malpractice in robotic surgery overall, to evaluate reasons for litigation, and to comment on possible strategies to avoid litigation with transoral robotic surgery. We used the Westlaw computerized database to identify all state and federal verdict summaries in medical malpractice cases. We found 17 cases alleging malpractice that involved the use of robotic surgery. In all, the plaintiffs in 6 cases (35%) contended that an open rather than a robotic approach should have been used, 5 (29%) alleged negligent credentialing, 4 (24%) alleged training deficiencies, 2 (12%) alleged manufacturing problems, and 1 (6%) charged that robotic surgery should have been performed instead of open surgery (1 case involved two of these allegations). In 11 cases (65%), plaintiffs charged that robotic surgery contributed to an undesirable outcome, and in 6 cases (35%) they raised concerns about informed consent. In all, only 5 of the 17 lawsuits (29%) resulted in plaintiff verdicts or settlements; damages ranged from $95,000 to $7.5 million. We believe the courts should not play a major role in establishing safety guidelines for the introduction of new technology such as robotic surgery. Instead, training and credentialing guidelines should be established by appropriate national associations and societies to assist hospitals in doing so.
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Affiliation(s)
- Mark A Fritz
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Bertolo R, Garisto J, Dagenais J, Sagalovich D, Kaouk JH. Single Session of Robotic Human Cadaver Training: The Immediate Impact on Urology Residents in a Teaching Hospital. J Laparoendosc Adv Surg Tech A 2018; 28:1157-1162. [DOI: 10.1089/lap.2018.0109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Sagalovich
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Jaffe TA, Hasday SJ, Knol M, Pradarelli J, Pavuluri Quamme SR, Greenberg CC, Dimick JB. Strategies for New Skill Acquisition by Practicing Surgeons. JOURNAL OF SURGICAL EDUCATION 2018; 75:928-934. [PMID: 28974428 DOI: 10.1016/j.jsurg.2017.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/27/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To understand how practicing surgeons utilize available training methods, which methods are perceived as effective, and important barriers to using more effective methods. DESIGN Online survey designed to characterize surgeon utilization and perception of available training methods. SETTING Two large Midwestern academic health centers. PARTICIPANTS 150 faculty surgeons. METHODS Nominal values were compared using a McNemar's Test and Likert-like values were compared using a paired t-test (IBM SPSS Statistics v. 21.0; New York, NY). RESULTS Survey response rate was 81% (122/150). 98% of surgeons reported learning a new procedure or technology after formal training. Many surgeons reported scrubbing in expert cases (78%) and self-directed study (66%), while few surgeons (6%) completed a mini-fellowship. The modalities used most commonly were scrubbing in expert cases (34%) and self-directed study (27%). Few surgeons (7%) believed self-directed study would be most effective, whereas 31% and 16% believed operating under supervision and mini-fellowships would be most effective, respectively. Surgeons believed more effective methods "would require too much time" or they had "confidence in their ability to implement safely." CONCLUSIONS Practicing surgeons use a variety of training methods when learning new procedures and technologies, and there is disconnect between commonly used training methods and those deemed most effective. Confidence in surgeon's ability was cited as a reason for this discrepancy; and surgeons found time associated with more effective methods to be prohibitive.
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Affiliation(s)
- Todd A Jaffe
- The University of Michigan Medical School, Ann Arbor, Michigan.
| | - Steven J Hasday
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Meghan Knol
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason Pradarelli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sudha R Pavuluri Quamme
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Caprice C Greenberg
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Justin B Dimick
- The University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, The University of Michigan, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 2018; 122:501-519. [PMID: 29603869 DOI: 10.1111/bju.14219] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. MATERIALS AND METHODS A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. RESULTS Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. CONCLUSION There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present.
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Affiliation(s)
| | - Jason Y Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anthony Costello
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Abstract
PURPOSE OF REVIEW Robot-assisted radical prostatectomy (RARP) has been embraced by urologists and has become a treatment standard in many countries already. Learning how to perform a RARP is challenging and has not yet been standardized. The current review summarizes the latest concepts regarding the most effective way of training for RARP. RECENT FINDINGS The strategy to learn RARP should comprise didactic activities, skills lab training, participating in surgeries and mentorship. Skills lab and virtual simulators are valuable tools to develop manual abilities and to overcome the initial technical learning curve. Participating in surgeries is crucial for familiarization with the robot installation, steps of the surgical procedure and is essential for troubleshooting. Mentorship improves learning and is the safest way to initiate real practice. Innate and individual background variances were suggested to influence the learning process; however, there is paucity of robust evidence correlating previous surgical experience and, for example videogame playing with faster learning of RARP. Structured curricula were proposed to orient the training for robotic surgery; currently, only one is focused exclusively on urology. SUMMARY Systematic training is the most effective way to learn and surpass the possibly intense learning curve of RARP. Training activities should focus on developing cognitive and manual abilities. The existing curricula for robotic surgery training still require constant refinement; however, they offer good and structured guidance to train for RARP.
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Abstract
Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment.
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Affiliation(s)
- R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - M F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - H J F Brenkman
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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Abstract
Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment.
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Van Bruwaene S, Namdarian B, Challacombe B, Eddy B, Billiet I. Introducing new technology safely into urological practice. World J Urol 2018; 36:543-548. [PMID: 29327248 DOI: 10.1007/s00345-018-2173-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Surgical innovation is necessary to ensure continued improvement in patient care. However, several challenges unique to the surgical craft are encountered during the development and validation of such new technology. This article highlights some of these challenges and gives an overview of existing solutions. METHODS A Pubmed review was performed about the "introduction of new technology" to identify challenges. Cross-referencing was used to explore the possible solutions per challenge. RESULTS Several characteristics of the surgical craft itself limit our ability to establish randomised controlled trials and hence provide clear categorical evidence. Existing certification bodies for new technology often use unstructured regulations and allow fast-track bypassing systems. Consequently the IDEAL framework (innovation, development, exploration, assessment, long-term follow-up) proposes an objective scientific approach whilst defining stakeholder responsibilities. The selection of which new modality to implement is heavily influenced by third parties unrelated to the best patient outcomes and thus professional organisations can aid in this decision-making. Appropriate training of surgeons and their teams until proficiency is achieved is essential prior to credentialling. Finally long-term surveillance of outcomes in the form of registries is an increasing responsibility of the urological community to maintain our role in directing the adoption or rejection of these innovations. CONCLUSION Urological innovation is a dynamic and challenging process. Increasing efforts are identified within the urological community to render the process more reliable and transparent.
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Affiliation(s)
| | | | - Ben Challacombe
- Guy's Hospital, Guy's and St Thomas' Trust (GSTT), London, UK
| | - Ben Eddy
- Kent and Canterbury Hospital, East Kent Hospital Trust (EKHUFT), Canterbury, UK
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Usluoğulları FH, Tıplamaz S, Yaycı N. Robotic surgery and malpractice. Turk J Urol 2017; 43:425-428. [PMID: 29201502 DOI: 10.5152/tud.2017.59013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/07/2017] [Indexed: 11/22/2022]
Abstract
Robotic surgery has undergone exponential growth since the last two decades. Employment of new technologies in surgery creates many ethical challenges concerning the advantages and disadvantages different from conventional surgery, ensuring safety of the new technology, giving permission to surgeons for using new technology, the way of informing patients before undergoing a new technology or technique, and the responsibilities of surgeons, firms and hospitals to the patients etc. In this review, robotic surgery was discussed from malpractice perspective.
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Affiliation(s)
| | - Sıtkı Tıplamaz
- Deparment of Forensic Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Nesime Yaycı
- Deparment of Forensic Medicine, Marmara University School of Medicine, İstanbul, Turkey
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Montroy J, Elzayat E, Morash C, Blew B, Lavallée LT, Cagiannos I, Watterson J, Oake JS, Fungkeefung M, Thompson C, Weber R, Breau RH. Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation. Can Urol Assoc J 2017; 12:38-43. [PMID: 29381463 DOI: 10.5489/cuaj.4528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is concern that surgical quality initially declines during the learning phase of robotic surgery. At our institution, we used a multi-surgeon programmatic approach to the introduction of robotic surgery. The purpose of this study was to evaluate outcomes of patients treated during the first year of our program. METHODS This is a historical cohort of all radical prostatectomy patients during a one-year period. Baseline, perioperative, and long-term followup data were prospectively and retrospectively collected. Treatment failure was a composite of any postoperative radiation, androgen-deprivation, or prostate-specific antigen (PSA) ≥0.2. RESULTS During the study period, 225 radical prostatectomy procedures were performed (104 robotic and 121 open). Baseline characteristics were similar between groups (p>0.05). All patients were continent and 74% were potent prior to surgery. Mean estimated blood loss (280 cc vs. 760 cc; p<0.001) and blood transfusion (0% vs. 8.3%; p=0.002) was lower in the robotic cohort. Non-transfusion complications were similar between groups (13% vs. 12%; p=0.7). Mean hospital stay was shorter in the robotic cohort (1.4 vs. 2.5 days). There was no difference in overall positive margin rate (38% vs. 43%; p=0.4) or treatment failure at a median followup of 3.5 years (p=0.4). Robotically treated patients were more often continent (89% vs. 77%; p=0.02) and potent (48% vs. 32%; p=0.02). CONCLUSIONS Using an inclusive multi-surgeon approach, robotic pros-tatectomy was introduced safely at a Canadian academic institution.
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Affiliation(s)
- Joshua Montroy
- The Ottawa Hospital Research Institute, University of Ottawa; Ottawa, ON, Canada
| | - Ehab Elzayat
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Luke T Lavallée
- The Ottawa Hospital Research Institute, University of Ottawa; Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - James Watterson
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Jeffrey S Oake
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Michael Fungkeefung
- Department of Gynecology, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Calvin Thompson
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
| | - Robert Weber
- Department of Nursing, The Ottawa Hospital; Ottawa, ON, Canada
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, University of Ottawa; Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa; Ottawa, ON, Canada
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Morris C, Hoogenes J, Shayegan B, Matsumoto ED. Towards development and validation of an intraoperative assessment tool for robot-assisted radical prostatectomy training: results of a Delphi study. Int Braz J Urol 2017; 43:661-670. [PMID: 28379668 PMCID: PMC5557442 DOI: 10.1590/s1677-5538.ibju.2016.0420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/01/2017] [Indexed: 01/30/2023] Open
Abstract
Introduction As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Validated assessment metrics are lacking for many robot-assisted radical prostatectomy (RARP). As it is quickly becoming the gold standard for treatment of localized prostate cancer, the development and validation of a RARP assessment tool for training is timely. Materials and methods We recruited 13 expert RARP surgeons from the United States and Canada to serve as our Delphi panel. Using an initial inventory developed via a modified Delphi process with urology residents, fellows, and staff at our institution, panelists iteratively rated each step and sub-step on a 5-point Likert scale of agreement for inclusion in the final assessment tool. Qualitative feedback was elicited for each item to determine proper step placement, wording, and suggestions. Results Panelist’s responses were compiled and the inventory was edited through three iterations, after which 100% consensus was achieved. The initial inventory steps were decreased by 13% and a skip pattern was incorporated. The final RARP stepwise inventory was comprised of 13 critical steps with 52 sub-steps. There was no attrition throughout the Delphi process. Conclusions Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus. This final inventory will be used to develop a valid and psychometrically sound intraoperative assessment tool for use during RARP training and evaluation, with the aim of increasing competency of all trainees.
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Affiliation(s)
- Christopher Morris
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
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Madureira FAV, Varela JLS, Madureira D, D'Almeida LAV, Madureira FAV, Duarte AM, Vaz OP, Ramos JR. Model of a training program in robotic surgery and its initial results. Rev Col Bras Cir 2017; 44:302-307. [PMID: 28767807 DOI: 10.1590/0100-69912017003013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/27/2017] [Indexed: 01/29/2023] Open
Abstract
Objective: to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. Methods: we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. Results: two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major complications. Conclusion: the robotic surgery program of the Samaritan Hospital was safely implemented and with initial results better than the ones described in the current literature. There seems to be benefits in using the robotic platform in super-obese patients, re-operations of obesity surgery and hiatus hernias, giant and paraesophageal hiatus hernias, ventral hernias with multiple defects and rectal resections.
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Affiliation(s)
- Fernando Athayde Veloso Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil.,Hospital Gaffrée Guinle da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brasil
| | | | - Delta Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Otávio Pires Vaz
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | - José Reinan Ramos
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
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Safety considerations in learning new procedures: a survey of surgeons. J Surg Res 2017; 218:361-366. [PMID: 28985875 DOI: 10.1016/j.jss.2017.06.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND There exists a tension between surgical innovation and safety. The learning curve associated with the introduction of new procedures/technologies has been associated with preventable patient harm. Surgeon's perceptions regarding the safety of methods for learning new procedures/technologies are largely uncharacterized. MATERIALS AND METHODS A survey was designed to evaluate surgeons' perceptions related to learning new procedures/technologies. This included clinical vignettes across two domains: (1) experience with an operation (e.g., colectomy) and (2) experience with a technology (e.g., laparoscopy). This study also focuses on a surgeon's perceptions of existing credentialing/privileging requirements. Participants were faculty surgeons (n = 150) at two large Midwestern academic health centers. RESULTS Survey response rate was 77% (116/150). 69% of respondents believed the processes of credentialing/privileging is "far too relaxed" or "too relaxed" for ensuring patient safety. Surgeons most commonly indicated a mini-fellowship is required to learn a new laparoscopic procedure. However, that requirement differed based on a surgeon's prior experience with laparoscopy. For example, to learn laparoscopic colectomy, 35% of respondents felt a surgeon with limited laparoscopic experience should complete a mini-fellowship, whereas 3% felt this was necessary if the surgeon had extensive laparoscopic experience. In the latter scenario, most respondents felt a surgeon should scrub in cases performed by an expert (38%) or perform cases under a proctor's supervision (33%) when learning laparoscopic colectomy. CONCLUSIONS Many surgeons believe existing hospital credentialing/privileging practices may be too relaxed. Moreover, surgeons believe the "one-size-fits-all" approach for training practicing surgeons may not protect patients from unsafe introduction of new procedures/technologies.
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Murthy PB, Schadler ED, Orvieto M, Zagaja G, Shalhav AL, Gundeti MS. Setting up a pediatric robotic urology program: A USA institution experience. Int J Urol 2017; 25:86-93. [DOI: 10.1111/iju.13415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/07/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Prithvi B Murthy
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Eric D Schadler
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Marcelo Orvieto
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Gregory Zagaja
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Arieh L Shalhav
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Mohan S Gundeti
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
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Mehta A, Patel S, Robison W, Senkowski T, Allen J, Shaw E, Senkowski C. Can teenage novel users perform as well as General Surgery residents upon initial exposure to a robotic surgical system simulator? J Robot Surg 2017; 12:165-171. [PMID: 28585104 DOI: 10.1007/s11701-017-0715-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
New techniques in minimally invasive and robotic surgical platforms require staged curricula to insure proficiency. Scant literature exists as to how much simulation should play a role in training those who have skills in advanced surgical technology. The abilities of novel users may help discriminate if surgically experienced users should start at a higher simulation level or if the tasks are too rudimentary. The study's purpose is to explore the ability of General Surgery residents to gain proficiency on the dVSS as compared to novel users. The hypothesis is that Surgery residents will have increased proficiency in skills acquisition as compared to naive users. Six General Surgery residents at a single institution were compared with six teenagers using metrics measured by the dVSS. Participants were given two 1-h sessions to achieve an MScoreTM in the 90th percentile on each of the five simulations. MScoreTM software compiles a variety of metrics including total time, number of attempts, and high score. Statistical analysis was run using Student's t test. Significance was set at p value <0.05. Total time, attempts, and high score were compared between the two groups. The General Surgery residents took significantly less Total Time to complete Pegboard 1 (PB1) (p = 0.043). No significant difference was evident between the two groups in the other four simulations across the same MScoreTM metrics. A focused look at the energy dissection task revealed that overall score might not be discriminant enough. Our findings indicate that prior medical knowledge or surgical experience does not significantly impact one's ability to acquire new skills on the dVSS. It is recommended that residency-training programs begin to include exposure to robotic technology.
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Affiliation(s)
- A Mehta
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - S Patel
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA.
| | - W Robison
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - T Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - J Allen
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - E Shaw
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - C Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
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Gosavi A, Vijayakumar PD, Ng BSW, Loh MH, Tan LG, Johana N, Tan YW, Sandikin D, Su LL, Wataganara T, Biswas A, Choolani MA, Mattar CNZ. Rapid initiation of fetal therapy services with a system of learner-centred training under proctorship: the National University Hospital (Singapore) experience. Singapore Med J 2017; 58:311-320. [PMID: 27439783 PMCID: PMC5474526 DOI: 10.11622/smedj.2016127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units. METHODS Five pregnancies with fetal complications were identified for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision. RESULTS All co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise. DISCUSSION Proctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefit other small units committed to providing these services.
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Affiliation(s)
- Arundhati Gosavi
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
| | - Pradip D Vijayakumar
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
| | - Bryan SW Ng
- Department of Anaesthesia, National University Health System, Singapore
| | - May-Han Loh
- Department of Anaesthesia, National University Health System, Singapore
| | - Lay Geok Tan
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nuryanti Johana
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Yi Wan Tan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Dedy Sandikin
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tuangsit Wataganara
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mahesh A Choolani
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Citra NZ Mattar
- Department of Obstetrics and Gynaecology, National University Health System, Singapore
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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