Role and Training of the Bedside Surgeon in Robotic Surgery: A Survey Among French Urologists-in-Training

Abstract

Introduction Due to the development of robotic surgery, surgeons operating at the console are physically separated from the patient. They must rely on help from an assistant, also called bedside surgeon. This study aimed to investigate the habits and practices of French urologic residents when performing this role and to determine whether they expected specific training to qualify as bedside surgeons. Materials and Methods A web-based survey was sent to French urology residents and fellows using the mailing-list of the French Association of Urologists in Training (AFUF). Results Over a 3-month period, 86 residents and fellows responded to the survey. Seventy-five (87.2%) thought that an experience as bedside surgeon was useful to acquire console surgeon status and, more specifically, 48.2% of them indicated that this former experience was vital. Nearly 64% considered that learning robotic surgery was essential during residency and fellowship. Overall, 91.9% believed that bedside surgeons should receive a formal training. They were 69.7% to need 5 to 10 procedures to feel confident as bedside surgeon. Almost 75% underwent laparoscopic training on simulators. Having access to a surgery school significantly increased the probability of receiving laparoscopic training on simulators (p = 0.0033). Conclusion French urology residents and fellows expect a specific training program for bedside surgeons to increase their level of confidence and to get familiar with the device during their first robotic procedures. For them, a bedside surgeon program on a regional/national level would be required.

Experience matters for robotic assistance: an analysis of case data

“…Bedside assistance is frequently described as a stepping stone on the path to console surgeon [4][5][6]. Prior work has acknowledged the multiple skills required as an assistant, and learning curve analysis has suggested that 10-36 cases are required for proficient bedside assistance [2,7].…”

Robotic Plastic Surgery Education: Developing a Robotic Surgery Training Program Specific to Plastic Surgery Trainees

“…A comprehensive RAS training program should include three basic components: theoretical knowledge, simulation, and bedside assist and console management. 23 Alongside learning these technical skills, successful robotic surgery also requires mastery of multiple nontechnical skills (NTS). All of these components will be discussed in detail below.…”

“…Preconsole training should ensure that trainees have a foundational knowledge of the robotic system and have participated in an adequate number of RAS cases as the bedside assistant. 23 As the bedside assistant, performance of critical tasks such as trocar placement, robot docking, efficient instrument exchange, lavage, and troubleshooting develop both technical and operational RAS skills. Bedside assisting also portends experience in active, direct communication with the console surgeon, as the bedside assist is often the sole person at the patient's side during the case and maintains visualization of the global operating field.…”

“…Current literature sites an appropriate range of 5 to 20 cases as bedside assistant, most often starting in the second year of training, before progressing to console surgeon. 23…”

The definition of ideal training of a urology resident from two different perspectives: trainees vs professors. Is there agreement in their idea of good training?

“…In recent years, training has become a topic under the spotlight, with growing importance day after day, also in urology. Although there are articles evaluating the quality of teaching in some countries, as well as the work conditions, the residents’ laparoscopic and robotics skills, and the use of social media for learning purposes [ 4 – 12 ], a global comprehensive and objective evaluation of ideal urological teaching is still lacking.…”