Current training on the basics of robotic surgery in the Netherlands: Time for a multidisciplinary approach?

Introduction

The following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training?

Methods

An online questionnaire was sent to 91 robot professionals in The Netherlands. The questionnaire contained 21 multiple-choice questions focusing on demographics, received robot training, and their opinion on basic skills training in robotic surgery.

Results

The response rate was 62 % (n = 56): 13 general surgeons, 16 gynecologists, and 27 urologists. The urologists performed significantly more robotic procedures than surgeons and gynecologists. The kind of training of all professionals varied from a training program by Intuitive Surgical, master-apprenticeship with or without duo console, fellowship, and self-designed training programs. The training did neither differ significantly among the different specialties nor the year of starting robotic surgery. Majority of respondents favor an obliged training program including an examination for the basics of robot skills training.

Conclusion

Training of the current robot professionals is mostly dependent on local circumstances and the manufacturer of the robot system. Training is independent of the year of start with robotic surgery and speciality. To guarantee the quality of future training of residents and fellows in robot-assisted surgery, clear training goals should be formulated and implemented. Since this study shows that current training of different specialities does not differ, training in robotic surgery could be started by a multidisciplinary basic skills training and assessment.

Electronic supplementary material

The online version of this article (doi:10.1007/s00464-016-4970-2) contains supplementary material, which is available to authorized users.

Thoracoscopic lobectomy: comparison of intraoperative and postoperative outcomes between 3 and 4 incision accesses

AIMS AND BACKGROUND

Several techniques have been proposed to perform a video-assisted thoracic lobectomy. We compared the results of a 3 versus 4-port procedure, analyzing intraoperative data, morbidity, and mortality.

METHODS

Prospective analysis of 30 consecutive patients who underwent a 4-port approach video-assisted thoracic lobectomy (group A) and comparison with a historical series with 30 patients who had a 3-port video-assisted thoracic lobectomy (group B).

RESULTS

The groups were comparable for clinical characteristics and pathological staging. There was no difference in operating time: median, 128 min for group A versus 129 min for group B (P = 0.9). There was a significant difference in rate of conversion to thoracotomy: 1 of 30 (3.3%) in group A and 7 of 30 (23.3%) in group B (3 ports) (P = 0.02). In group A, 11 patients (36.7%) experienced postoperative complications and in group B, 13 patients (43.3%; P = 0.6). The difference in median time to drain removal and median length of hospital stay between the two groups was not significant. There was a significant difference in persistent pain between group A and group B: 6 patients (20%) in group B presented with persistent neuropathic pain on regular medication (P = 0.02).

CONCLUSIONS

Our study showed that the 4-port approach was similar in operative time, length of drain and hospital stay but showed a statistically significant lower conversion rate and lower rate of persistent pain than the 3-port access.

Thoracoscopic Lobectomy: Comparison of Intraoperative and Postoperative Outcomes between 3 and 4 Incision Accesses

Aims and background

Several techniques have been proposed to perform a video-assisted thoracic lobectomy. We compared the results of a 3 versus 4-port procedure, analyzing intraoperative data, morbidity, and mortality.

Methods

Prospective analysis of 30 consecutive patients who underwent a 4-port approach video-assisted thoracic lobectomy (group A) and comparison with a historical series with 30 patients who had a 3-port video-assisted thoracic lobectomy (group B).

Results

The groups were comparable for clinical characteristics and pathological staging. There was no difference in operating time: median, 128 min for group A versus 129 min for group B (P = 0.9). There was a significant difference in rate of conversion to thoracotomy: 1 of 30 (3.3%) in group A and 7 of 30 (23.3%) in group B (3 ports) (P = 0.02). In group A, 11 patients (36.7%) experienced postoperative complications and in group B, 13 patients (43.3%; P = 0.6). The difference in median time to drain removal and median length of hospital stay between the two groups was not significant. There was a significant difference in persistent pain between group A and group B: 6 patients (20%) in group B presented with persistent neuropathic pain on regular medication (P = 0.02).

Conclusions

Our study showed that the 4-port approach was similar in operative time, length of drain and hospital stay but showed a statistically significant lower conversion rate and lower rate of persistent pain than the 3-port access.