Robotic Thoracic Surgery Training for Residency Programs

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice. </jats:p></jats:sec>

Suggested robotic-assisted thoracic surgery training curriculum

“…In this milestone-based curriculum of thoracic surgery training, robotics training is set as a "level five" milestone in which trainees are trained in the care of patients' lungs and airways by acquiring technical skills (40). This milestone is considered to be an extraordinary milestone for thoracic surgery trainees and is not mandatory for everyone to reach (41).…”

“…In PGY 2-3, trainees complete their learning from online modules, virtual reality, simulator training, and workshops. Conversely, the trainee in PGY 4-6 should be involved in more structural clinical learning, including docking, instrument insertion and exchange, and assisting console surgeons to achieve tissue retraction and hemostasis (41). Thus, this newly proposed curriculum can be incorporated into the previous milestone-based curriculum to ensure the production of competent robotic thoracic surgeons after graduation (41,42).…”

“…Conversely, the trainee in PGY 4-6 should be involved in more structural clinical learning, including docking, instrument insertion and exchange, and assisting console surgeons to achieve tissue retraction and hemostasis (41). Thus, this newly proposed curriculum can be incorporated into the previous milestone-based curriculum to ensure the production of competent robotic thoracic surgeons after graduation (41,42). A survey of program directors showed that most support the introduction of thoracic robotic surgery training in thoracic residency programs, and several of these program directors suggested robotic surgery training as a mandatory aspect of thoracic surgery training.…”

“…After evaluation, trainees should receive certification for their training by a thoracic surgery society or certification body (43). One of the suggested certification methods is to submit videos of procedures done by the trainee to the certifying body for evaluation and certification, and it is preferred to repeat certifications at regular intervals to maintain robotic thoracic surgery quality (41).…”

Der Stellenwert des Feedbacks beim Proctoring in der robotergestützten Chirurgie – ein Grundstein des Erfolgskonzeptes?

“…In Bezug auf das Training in der robotergestützten Chirurgie gibt es zwar einzelne Empfehlungen zum Hands-on-Training oder zur Anzahl der assistierten Eingriffe, hingegen fehlt ein strukturiertes Curriculum, das die Entwicklung in der minimalinvasiven, und speziell der robotergestützten Chirurgie, begleitet und sinnvoll strukturiert. Training und Erfahrung finden nach wie vor besonders im Operationssaal an realen Menschen statt 7 8 9 .…”