Implementation of a comprehensive competency‐based transoral robotic surgery training curriculum with ex vivo dissection models

Sobel, Ryan H.; Blanco, Ray; Ha, Patrick K.; Califano, Joseph A.; Kumar, Rajesh; Richmon, Jeremy D.

doi:10.1002/hed.24475

Cited by 22 publications

(30 citation statements)

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“…The curriculum was centered on robotic cadaveric dissection. Prior work has described TORS training for residents [13-15]; however, to our knowledge, this is the first report of a TORS residency curriculum with use of the actual robotic surgical system on human cadavers followed by assessment of TORS skills.…”

Section: Discussionmentioning

confidence: 96%

“…In comparison to the current study, Sobel et al [15] published their TORS curriculum in an ex vivo model in which performance was assessed by objective structured assessments of technical skills. In the future, an objective structured assessment of technical skills could be incorporated into our curriculum.…”

Section: Discussionmentioning

confidence: 99%

“…Curry et al [14] utilized an inanimate robot skills laboratory followed by docking and positioning on a mannequin, ending with a surgical dissection of porcine tongue to help prepare residents for their transition to the operating room. Further work using objective assessment of technical skills with this ex vivo model showed improvement in resident performance before and after the dissections [15]. Sperry et al [13] developed a curriculum with didactics as well as a tutorial in basic controls, function, room setup, and positioning.…”

Section: Introductionmentioning

confidence: 99%

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Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents

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Sharma²

2018

ORL

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Purpose of the Study: (1) To develop a multifaceted didactic and hands-on curriculum to prepare otolaryngology residents to perform transoral robotic surgery (TORS) and safely transition to the operating room. (2) To assess the effectiveness of the TORS curriculum. Procedures: Learning objectives were developed and a curriculum was formulated utilizing five unique modalities: focused didactic reading, online training modules, backpack console simulations, videos of TORS cases, and hands-on cadaveric dissections with the robotic surgical system in a simulated operating room. The trainees completed a nine-item self-assessment of their skill level using a Likert scale. Results: Five senior otolaryngology residents completed the TORS curriculum. Before and after the cadaveric dissections, there was improvement in each of the nine items assessed. Composite scores were calculated and there was significant improvement from predissection (15.2 ± 2.2) to postdissection (31.4 ± 1.9) (p = 0.002). Conclusions: The current study demonstrates the feasibility of implementing a multifaceted TORS curriculum which incorporates robotic cadaveric dissection for otolaryngology residents. Residents demonstrate marked improvement in skills with the TORS curriculum. A TORS curriculum which includes robotic cadaveric dissection can improve surgical skills and serve as a key component of residency TORS education.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents

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2018

ORL

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“…The authors evaluated 12 resident trainees as they performed a combination of virtual simulation tasks, three simulated oropharynx surgeries using a porcine model, and task‐trainer exercises. The authors found significant improvement in resident OSATS scores and margin status, but not resection time, between TORS‐naïve versus curriculum‐trained subjects …”

Section: Introductionmentioning

confidence: 94%

“…Robotic surgery training paradigms are not standardized and are highly variable . They commonly employ commercially available task trainers and virtual simulators to teach basic techniques for controlling an Intuitive Surgical (Sunnyvale, CA) da Vinci system.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of high‐fidelity simulation as a training tool in transoral robotic surgery

et al. 2017

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Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

et al. 2021

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elanoma is one of the most common cancers in the US, with 106 110 incident cases estimated to be diagnosed in 2021. 1 Although the standard therapy for localized invasive melanoma is wide local excision, Mohs micrographic surgery (MMS) has been increasingly used as an alternative excisional approach, [2][3][4] with a recent study reporting that 7.9% of surgical melanoma cases in 2016 were excised using MMS. 5 Mohs micrographic surgery offers the advantage of complete margin evaluation during the procedure while potentially limiting healthy tissue removal. Such complete margin evaluation is especially helpful in the case of facial tumors, for which National Comprehensive Cancer Network guidelines state that margins may be reduced for anatomic considerations, or tumors with clinically indistinct borders, such as lentigo maligna melanoma, for which appropriate margins may be difficult to determine clinically. 2,6 Recent work suggests that treatment of early-stage (T1a-T2a category) melanoma with MMS is associated with a modest survival advantage compared with traditional wide local excision. 7 An additional consideration for the more technically complex MMS for melanoma procedure is how effectively it can be applied across centers. Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how such factors may IMPORTANCE Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery.OBJECTIVE To evaluate the association of treatment center academic affiliation and case volume with long-term patient survival after MMS for T1a-T2a invasive melanoma. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study, 4062 adults with nonmetastatic, T1a-T2a melanoma diagnosed from 2004 to 2014 and treated with MMS in the National Cancer Database (NCDB) were identified. The NCDB includes all reportable cases from Commission on Cancer-accredited facilities and is estimated to capture approximately 50% of all incident melanomas in the US. Multivariable survival analyses were conducted using Cox proportional hazards models. Data analysis was conducted from February 27 to August 18, 2020. EXPOSURES Treatment facility characteristics.MAIN OUTCOMES AND MEASURES Overall survival. RESULTSThe study population included 4062 patients (2213 [54.5%] men; median [SD] age, 60 [16.3] years) treated at 462 centers. Sixty-two centers were top decile-volume facilities (TDVFs), which treated 1757 patients (61.9%). Most TDVFs were academic institutions (37 of 62 [59.7%]). On multivariable analysis, treatment at an aca...

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Implementation of a comprehensive competency‐based transoral robotic surgery training curriculum with ex vivo dissection models

Abstract: This graduated curriculum provides a realistic training experience to develop competency with oropharyngeal resections before transition to the operating room. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1563, 2016.

Cited by 22 publications

References 16 publications

Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents

Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents

Evaluation of high‐fidelity simulation as a training tool in transoral robotic surgery

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

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