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.

Novice surgeons versus experienced surgeons in laparoendoscopic single-site (LESS) surgery: a comparison of performances in a surgical simulator

INTRODUCTION

During the past years, there has been increasing interest in simulation-based training of technical skills especially in laparoscopy. The purpose of this study was to compare the performances of novice and experienced laparoscopic surgeons on a LESS simulator.

METHODS

The study recruited 20 surgeons classified into two groups: group NS consisted of ten residents without any laparoscopic experience, and group ES consisted of ten surgeons with experience in conventional laparoscopy (performed >90 laparoscopic cholecystectomies) but without any experience in LESS surgery. Both groups completed a mini-trainee course that included four repetitions of a standardized task of circle pattern cutting (CIRCLE). Time, path length, and economy of movement were measured and compared.

RESULTS

Group ES presented significantly better time scores than group NS in all four repetitions. Economy of movement did not differ significantly between the two groups, whereas path length was shorter for beginners at the forth effort. Moreover, group ES failed to improve path length and economy of movement scores, whereas group NS improved their performance significantly in these parameters.

CONCLUSIONS

It seems that previous laparoscopic experience in conventional laparoscopy may not necessarily be an advantage in all parameters of LESS surgery and the learning process can be longer than expected even for experienced surgeons.

Enhancement of X-ray toxicity in squamous cell carcinoma cell lines by DNA polymerase inhibitors

The effect of the DNA polymerase inhibitors adenine 9-beta-arabinofuranoside (ara-A), cytosine 1-beta-arabinofuranoside (ara-C), and aphidicolin on X-radiation sensitivity was studied in a group of exponentially growing squamous cell carcinoma cell lines. The tumour cell lines varied in radiation sensitivity, with D0 (radiation sensitivity) values ranging from 1.0 to 3.9 Gy. The addition of non-toxic concentrations of ara-A 30 min before irradiation and removal 30 min after irradiation potentiated cell killing in five of eight cell lines. Four of these five responsive cell lines were relatively radioresistant lines, having D0 > 2.0 Gy. One of the cell lines was more radiosensitive (D0 = 1.4 Gy). Ara-A was also effective in potentiating killing in the radioresistant cell lines even when added 60 min after irradiation. Pre- or post-treatment with ara-A had no effect on X-ray sensitivity of the other three relatively sensitive cell lines (D0 ranging from 1.0 to 1.3 Gy). Both ara-C and aphidicolin were effective in potentiating X-ray sensitivity in JSQ-3, a relatively resistant cell line that was sensitized by ara-A treatment, but they had no effect on the X-ray sensitivity of SCC-61, a relatively radiosensitive cell line that was insensitive to ara-A effects on X-ray response. At the concentrations used, the polymerase inhibitors were equally effective in inhibiting DNA synthesis.

Pre-operative short intensive radiation therapy of T3-T4 laryngeal carcinoma

A group of 33 patients with T3-T4 laryngeal carcinomas received in the period 1968 to 1972 pre-operative irradiation with 60Co followed by surgery. A total dose of 2 500 rad was given in 5 equal sesssions. The tumour free survival rates of these patients are compared to those of a comparable group of 57 patients receiving radiation therapy only. The overall results in the pre-operative group (64%) are superior to those in the group irradiated only. In glottic tumours the results were similar in both groups, but significantly superior in supraglottic tumours receiving pre-operative radiation therapy. The treatment schedule proposed is well-tolerated and surgery is usually performed before the onset of reaction.