A review of clinical and oncological outcomes following the introduction of the first robotic colorectal surgery programme to a university teaching hospital in Ireland using a dual console training platform

Fleming, Christina; Westby, Daniel; Ullah, Mohammad Fahad; Mohan, Helen; Sehgal, Rishabh; Bolger, Jarlath; O’Leary, Donal Peter; McNamara, Emma; Korpanty, Grzegorz; Bassiouni, Mazen El; Condon, Eoghan; Coffey, J. Calvin; Peirce, Colin

doi:10.1007/s11701-020-01073-8

Cited by 19 publications

(15 citation statements)

References 20 publications

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“…29 In another recent report, the author surveyed the robotic surgery training curricula in general surgery, and reported difficulty in quantifying resident experience and assessing competence for safe robotic surgery practices since there has not yet been sufficient adoption of a standardized program. 30 Due to the characteristics of its modalities, robotic surgery requires attention to its unique disadvantage, in which losing sight of the instrument or the lack of tactile feedback could easily result in damage to other organs. Furthermore, when surgeons experienced difficult-tocontrol bleeding, it was difficult to convert from robotic to open surgery.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

et al. 2021

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Background Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. Methods We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. Results The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. Conclusion Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.

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Section: Discussionmentioning

confidence: 99%

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

et al. 2021

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“…The most frequent criticisms of robotic surgery are those of increased cost and a longer operating time compared to laparoscopic approaches as a result of the expense of acquiring and utilizing robotic surgical systems and the learning curve associated with robotic docking [4,5]. The current literature reports that the additional cost of R-TAMIS compared to L-TAMIS is approximately €1000 per procedure [6]. This is not insignificant, but may be justified by the ergonomic advantages offered by robotic systems allowing safer and more efficient removal of rectal lesions [1-5, 7, 8].…”

Section: Discussionmentioning

confidence: 99%

“…Following this, the patient opted to proceed with R-TAMIS. The procedure was performed by a fellowshiptrained consultant colorectal surgeon on the specialist division of the medical register who had completed a proctorship programme in robotic colorectal surgery and achieved certification with the European Association of Robotic Colorectal Surgery [6]. The surgeon had also performed the required number of cases for competency in L-TAMIS [1].…”

Section: Case Presentationmentioning

confidence: 99%

The first robotic transanal minimally invasive surgery in Ireland: a case-based review

et al. 2021

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Transanal minimally invasive surgery (TAMIS) has gained worldwide acceptance as a means of local excision of early rectal cancers and benign rectal lesions. However, it is technically challenging due to the limitations of rigid laparoscopic instruments in the narrow rectal lumen. Robotic platforms offer improved ergonomics that are valuable in operative fields with limited space. Robotic TAMIS represents an exciting new development that may be more versatile than traditional TAMIS. In this review, we describe the first case of robotic TAMIS performed in our country and a review of current literature on the technique.

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“…Potential obstacles include overcoming the learning curve, the potential harm to patients during residency training, and increased operative times during skill development. 12 Fleming et al, reported that oncologic outcomes for colon and rectal cancer while training residents on a dual console robotic platform has been shown to effectively have up to a 97% R0 resection rate. 12 While training residents in laparoscopy results in longer operative times, there was no difference in successful outcomes, reoperation, or complications versus the attending surgeons.…”

mentioning

confidence: 99%

“…12 Fleming et al, reported that oncologic outcomes for colon and rectal cancer while training residents on a dual console robotic platform has been shown to effectively have up to a 97% R0 resection rate. 12 While training residents in laparoscopy results in longer operative times, there was no difference in successful outcomes, reoperation, or complications versus the attending surgeons. 13 A large National Surgical Quality Improvement Program study found that training residents is safe for patient care despite a slight increase in operative time and surgical site infections.…”

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confidence: 99%

Teaching and Training Surgeons in Robotic Colorectal Surgery

Soliman¹,

Tammany²

2021

Clin Colon Rectal Surg

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Robotic surgery is becoming more popular among practicing physicians as a new modality with improved visualization and mobility (1–2). As patients also desire minimally invasive procedures with quicker recoveries, there is a desire for new surgical residents and fellows to pursue robotic techniques in training (3–4). To develop a new colorectal robotics training program, an institution needs a well-formulated plan for the trainees and mentors with realistic expectations. The development of a robotics training program has potential obstacles, including increased initial cost, longer operative times, and overcoming learning curves. We have devised a four-phase training protocol for residents in colorectal surgical fellowship. Each of these phases attempts to create a curricular framework that outlines logical progression and sets expectations for trainees, Program Directors, and residency faculty. Phase zero begins prior to fellowship and is preparatory. Phase one focuses on an introduction to robotics with learning bedside console troubleshooting and simulation exercises. Phase Two prioritizes operative experience and safety while completing steps independently in a progressive fashion. Phase Three polishes the resident prior to graduation for future practice. We recommend frequent evaluation and open-mindedness while establishing a focused robotics program. The end goal is to graduate fellows with an equivalency certificate who can continue to practice colorectal robotic surgery.

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A review of clinical and oncological outcomes following the introduction of the first robotic colorectal surgery programme to a university teaching hospital in Ireland using a dual console training platform

Cited by 19 publications

References 20 publications

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

The first robotic transanal minimally invasive surgery in Ireland: a case-based review

Teaching and Training Surgeons in Robotic Colorectal Surgery

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