Robotic Surgical Training in an Academic Institution

Abstract

ObjectiveTo detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background DataRemote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. MethodsAdvanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors' two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. ResultsEstablished surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. ConclusionRobotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely.Surgeons always have sought methods to develop new operations, but many times have been limited by technology. In many instances, initial endoscopic surgical training of senior surgeons and residents alike proceeded along variable pathways without significant prior procedure development or detailed curricula. Early clinical training frequently was at the expense of the best surgical results. Bonchek, 1 Lytle, 2 and Cooley 3 have cautioned surgeons who veer from established techniques with proven results, even if much larger incisions are required.Multispecialty procedure development is very important when any new technology is introduced in surgery. Our trek for developing surgical robotics and training surgeons has been predicated on quality expected from conventional procedures, or "base camps." Progression to each successive level has been followed by technologic "acclimatization" and experience before attempting the last challenge to surgical telemanipulation.

The emerging role for robotics in cholecystectomy: the dawn of a new era?

“…The first RC was performed by Belgian Jacques Himpens in 1997, marking the first human use of the da Vinci ® surgical system (21). Since then, several studies have demonstrated that RC is safe and effective for general surgeons in the early part of their learning curve for robotic surgery (22,23). The learning curve for RC varies widely, ranging from a mean surgical time of 57-167 minutes (24).…”

Laparoscopic robotic-assisted gastrointestinal surgery: a Geneva experience

“…The follow-up was done during a patient's visit to the attending physician and/ or telephone interview. The patient's evaluation was obtaining using a visual analog score (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Approval by our local Ethics Committee was obtained prior to carrying out this study.…”

Robotic surgery: History and teaching impact

“…En 2003 otro estudio realizado por el mismo grupo reveló que aunque el 57% de los residentes de cirugía mostraba interés por la cirugía robótica, la mayoría (80%) no contaba con un programa de formación en cirugía robótica en las instituciones en que estudiaba 28 . Son pocos los centros académicos que han desarrollado una didáctica formal que enseñe a los alumnos a practicar este tipo de cirugía 29 .…”