Educational note: teaching and training in robotic surgery. An opinion of the Minimally Invasive and Robotic Surgery Committee of the Brazilian College of Surgeons

Abstract

With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.

The role of the bedside assistant in robot-assisted surgery: A critical synthesis

“…The literature supports that surgeons learning RAS should learn the role of BA at an early stage and look to maintain these skills, including the recent guidelines from the Minimally Invasive and Robotic Surgery Committee of the Brazilian College of Surgeons (Nácul et al 2020) or the Delphi exercise around core gynaecological RAS training curriculum in the United Kingdom (Ismail et al 2020). Certification for surgeons is strongly advocated (Veronesi et al 2018), however, some go on to note, this is not yet the case for the practitioner (surgeon or other) performing in the role of the BA.…”

Perfil de saúde hospitalar dos pacientes submetidos à cirurgia robótica: estudo retrospectivo observacional

“…Quanto menor o tempo de procedimento, menor o tempo de anestesia. Neste estudo, a maioria dos pacientes ficou submetida à anestesia por um período de 4 a 6 horas (57,5%), mostrando que o tempo de intervenção anestésica pode agregar maior fator de risco que a cirurgia (Nacul et al, 2020).…”

“…Um cirurgião que tenha realizado menos de 20 procedimentos cirúrgicos robóticos está no início da curva de aprendizagem do método (Ramos et al 2013). Todavia, nesses casos é necessária a presença de um cirurgião proctor que deve estar devidamente habilitado em cirurgia robótica e possuir experiência mínima de 35 a 50 procedimentos robóticos (Nacul et al, 2020).…”

Perspectivas em Cirurgia Robótica – a visão do cirurgião

“…A plataforma robótica não somente oferece todos os benefícios já bem documentados da videolaparoscopia, mas também inúmeras vantagens técnicas em relação a ela. [6][7][8][9][10] .…”

“…Em relação ao nível de conhecimento e interesse dos cirurgiões, observa-se que a totalidade dos respondentes declara ter conhecimento básico da técnica robótica e um terço da amostra já praticou algum tipo de treinamento, teórico, na plataforma ou em simuladores. Após o término da vida acadêmica, qualquer qualificação cirúrgica complementar requer tempo e recursos financeiros adicionais 9,10 . A oferta de cursos de capacitação na plataforma robótica ainda é escassa no país e demanda investimento financeiro de grande monta quando comparado a outros treinamentos na área cirúrgica 7 .…”