Abstract:Introduction:
The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP.
Materials and Methods:
We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we di… Show more
“…The majority of these (21) proved irrelevant, while the full text of one was not in English (Pograjec & Hubert 2019). Two records (Cimen et al 2019a, 2019b) were also excluded for lack of rigour/poor quality as apparently the same dataset was used to achieve different conclusions by excluding one or another variable, and whereas a combined analysis would have seemed more trustworthy. Finally, one other record was excluded (Goldenberg et al 2018) as it proved to be the abstract of an included study (Yu et al 2021).…”
Introduction: Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics. Aim: To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom. Methods: Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence. Results: Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence. Conclusion: The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
“…The majority of these (21) proved irrelevant, while the full text of one was not in English (Pograjec & Hubert 2019). Two records (Cimen et al 2019a, 2019b) were also excluded for lack of rigour/poor quality as apparently the same dataset was used to achieve different conclusions by excluding one or another variable, and whereas a combined analysis would have seemed more trustworthy. Finally, one other record was excluded (Goldenberg et al 2018) as it proved to be the abstract of an included study (Yu et al 2021).…”
Introduction: Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics. Aim: To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom. Methods: Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence. Results: Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence. Conclusion: The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
“…Operation time is another important factor in robotic surgery, as we reported in our previous study, it decreases with more experience for both the console surgeon and the bedside assistant ( 21 ). Guzzo et al reported that as the surgeons become more experienced at the bedside, they become more proficient in trocar port placement, docking and undocking, instrumentation and troubleshooting with greater accuracy ( 22 ).…”
Introduction:
To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy.
Materials and Methods:
The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate.
Results:
Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant.
Conclusion:
Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.
“…[ 20 – 23 ] The importance of bedside assistants in terms of surgical outcomes has also been shown in various robotic procedures, including complex gastrointestinal surgery, bariatric surgery, and prostatectomy. [ 13 – 16 ] However, little attention has been paid to the role of the assistant in robotic thyroid surgery. During BABA robotic thyroidectomy, the bedside assistant has important roles, including aligning the patient and robot in appropriate positions, which enables better control of the console surgeon, changing and mounting devices efficiently, and providing effective suction and irrigation to make a clear surgical field of view.…”
Section: Discussionmentioning
confidence: 99%
“…[ 13 ] Previous studies have demonstrated that higher levels of experience of the surgical assistants are associated with reduced operative times, less blood loss, and lower overall complication rates. [ 13 – 16 ] Moreover, participation of trainees resulted in higher rates of anastomosis leakage, readmissions, re-interventions, and complications. [ 14 ] In contrast, Abu-Ghanem et al [ 17 ] found that assistant's experience levels had no influence on operative outcomes.…”
The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA.
Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed.
Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ± 33.6 minutes vs 203.1 ± 37.9 minutes;
P
< .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ± 37.3 minutes vs 172.8 ± 26.4 minutes;
P
< .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance.
Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.
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