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Wynn J, Costello A, Larkins K, Costello D, Ghazi A, Ryan K, Barry K, Gray M, Gallagher A, Hung A, Heriot A, Warrier S, Reeves F, Collins J, Dundee P, Peters J, Homewood D, Driscoll D, Niall O, Fay T, Sachdeva A, Woo H, Satava R, Mohan H. IMRA/SRS Delphi consensus on international standards for common core components of robotic surgical training design. J Robot Surg 2024; 18:342. [PMID: 39298048 DOI: 10.1007/s11701-024-02057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/20/2024] [Indexed: 09/21/2024]
Abstract
Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include-training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended.
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Affiliation(s)
- Jessica Wynn
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | - Anthony Costello
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | - Kirsten Larkins
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Costello
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ahmed Ghazi
- Department of Urology, John Hopkins Hospital, Baltimore, MD, USA
| | - Kieran Ryan
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin Barry
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew Gray
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | | | - Andrew Hung
- Department of Urology, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Alexander Heriot
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Satish Warrier
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Farleigh Reeves
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Justin Collins
- Department of Urology, University College London Hospital, London, England
| | - Phil Dundee
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Justin Peters
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | - David Homewood
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | - Dean Driscoll
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
| | - Owen Niall
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Tayla Fay
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | | | - Henry Woo
- Royal Australasian College of Surgeons, Melbourne, VIC, Australia
| | | | - Helen Mohan
- International Medical Robotics Academy (IMRA), Melbourne, VIC, Australia.
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
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Erskine J, Abrishami P, Bernhard JC, Charter R, Culbertson R, Hiatt JC, Igarashi A, Purcell Jackson G, Lien M, Maddern G, Soon Yau Ng J, Patel A, Rha KH, Sooriakumaran P, Tackett S, Turchetti G, Chalkidou A. An international consensus panel on the potential value of Digital Surgery. BMJ Open 2024; 14:e082875. [PMID: 39242163 PMCID: PMC11381694 DOI: 10.1136/bmjopen-2023-082875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES The use of digital technology in surgery is increasing rapidly, with a wide array of new applications from presurgical planning to postsurgical performance assessment. Understanding the clinical and economic value of these technologies is vital for making appropriate health policy and purchasing decisions. We explore the potential value of digital technologies in surgery and produce expert consensus on how to assess this value. DESIGN A modified Delphi and consensus conference approach was adopted. Delphi rounds were used to generate priority topics and consensus statements for discussion. SETTING AND PARTICIPANTS An international panel of 14 experts was assembled, representing relevant stakeholder groups: clinicians, health economists, health technology assessment experts, policy-makers and industry. PRIMARY AND SECONDARY OUTCOME MEASURES A scoping questionnaire was used to generate research questions to be answered. A second questionnaire was used to rate the importance of these research questions. A final questionnaire was used to generate statements for discussion during three consensus conferences. After discussion, the panel voted on their level of agreement from 1 to 9; where 1=strongly disagree and 9=strongly agree. Consensus was defined as a mean level of agreement of >7. RESULTS Four priority topics were identified: (1) how data are used in digital surgery, (2) the existing evidence base for digital surgical technologies, (3) how digital technologies may assist surgical training and education and (4) methods for the assessment of these technologies. Seven consensus statements were generated and refined, with the final level of consensus ranging from 7.1 to 8.6. CONCLUSION Potential benefits of digital technologies in surgery include reducing unwarranted variation in surgical practice, increasing access to surgery and reducing health inequalities. Assessments to consider the value of the entire surgical ecosystem holistically are critical, especially as many digital technologies are likely to interact simultaneously in the operating theatre.
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Affiliation(s)
- Jamie Erskine
- Market Access, Alira Health, Boston, Massachusetts, USA
| | - Payam Abrishami
- Erasmus School of Health Policy and Management, National Health Care Institute, Rotterdam, The Netherlands
| | | | - Richard Charter
- Health Technology Assessment International, Edmonton, Alberta, Canada
- CHLOE Healthcare Advisory Group, London, UK
| | - Richard Culbertson
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jo Carol Hiatt
- Health Technology Assessment International, Edmonton, Alberta, Canada
| | | | - Gretchen Purcell Jackson
- Intuitive Surgical Inc, Sunnyvale, California, USA
- American Medical Informatics Association, Bethesda, Maryland, USA
| | - Matthew Lien
- Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Guy Maddern
- Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, Adelaide, Australia
| | | | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Koon Ho Rha
- Yonsei University Medical Center, Seodaemun-gu, Seoul, Republic of Korea
| | | | | | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Toscana, Italy
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Sakalkale A, Satheakeerthy S, Yeung JMC, Reid F. Robots down-under: the current climate of robotic-assisted surgery education in Australia. J Robot Surg 2024; 18:246. [PMID: 38850319 PMCID: PMC11162393 DOI: 10.1007/s11701-024-01994-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
Australia has seen a significant rise in the use of Robotic-Assisted Surgery (RAS), with general surgery being the fastest-growing field in this technology. The proportion of general surgical RAS has grown from 1% to 17% of all RAS between 2008 and 2023 in Australasia. As of May 2023, there were 162 robotic platforms in Australasia, with 26 of them in the public sector. As the cost of establishing RAS decreases over time, public hospital robotics systems are expected to become more accessible. Despite the increasing demand, many specialties, including general surgery, do not have an agreed RAS curriculum for trainees. It is imperative for Australia to develop its own curriculum akin to our overseas colleagues to match this growth.
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Affiliation(s)
- Aditya Sakalkale
- General Surgery, Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.
- Academic Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
| | - Shriranshini Satheakeerthy
- General Surgery, Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
- Academic Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Justin M C Yeung
- Colorectal Surgery Unit, Western Health, Footscray, VIC, Australia
- Academic Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Reid
- General Surgery, Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
- Academic Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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Lazar DJ, Ferzli GS. Is the robotic revolution stunting surgical skills? Surg Open Sci 2024; 19:63-65. [PMID: 38595831 PMCID: PMC11002294 DOI: 10.1016/j.sopen.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow. Key message The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.
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Affiliation(s)
- Damien J. Lazar
- New York University Langone Health, Department of General Surgery, New York, NY, United States of America
| | - George S. Ferzli
- New York University Langone Health, Department of General Surgery, New York, NY, United States of America
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Larkins K, Downie E, Mohan H, Warrier S, Heriot A. How to watch: a guide to structured operative observation and cognitive simulation for trainees. ANZ J Surg 2024; 94:8-10. [PMID: 37872825 DOI: 10.1111/ans.18745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Kirsten Larkins
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
| | - Emma Downie
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Mohan
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Satish Warrier
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
- Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, Melbourne University, Melbourne, Victoria, Australia
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Raffaelli M, Greco F, Pennestrì F, Gallucci P, Ciccoritti L, Salvi G, Procopio PF, Voloudakis N. Robotic-assisted Roux-en-Y gastric bypass with the novel platform Hugo TM RAS: preliminary experience in 15 patients. Updates Surg 2024; 76:179-185. [PMID: 37861973 PMCID: PMC10805871 DOI: 10.1007/s13304-023-01657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023]
Abstract
Robotic assisted surgery is a rapidly developing field in bariatric surgery. Its wide diffusion has led to the development and standardisation of robotic assisted approaches for various bariatric operations. However, further application has been limited thus far due to issues of cost-effectiveness and accessibility. The introduction of new robotic platforms may help overcome those obstacles. In this study, we present the first fifteen cases of Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA). From January to March 2023, consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were randomly selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied. Seven female and eight male patients with a median BMI of 42 (range: 36-50) and obesity-related comorbidities in eight cases underwent RYGB. The median docking time was 7 min (range: 6-8.5) and the median console time was 100 min (range: 70-150). Procedures were performed without intraoperative complications and no conversion to laparoscopy or open surgery was noted. Operative times were indicative of a steep learning curve. No early post-operative complications were observed. Based on our initial experience, RYGB with the Hugo™ RAS system is promising and may be integrated in established robotic programmes without requiring a long adaptation period.
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Affiliation(s)
- Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Priscilla Francesca Procopio
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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Casas-Yrurzum S, Gimeno J, Casanova-Salas P, García-Pereira I, García del Olmo E, Salvador A, Guijarro R, Zaragoza C, Fernández M. A new mixed reality tool for training in minimally invasive robotic-assisted surgery. Health Inf Sci Syst 2023; 11:34. [PMID: 37545486 PMCID: PMC10397172 DOI: 10.1007/s13755-023-00238-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 08/08/2023] Open
Abstract
Robotic-assisted surgery (RAS) is developing an increasing role in surgical practice. Therefore, it is of the utmost importance to introduce this paradigm into surgical training programs. However, the steep learning curve of RAS remains a problem that hinders the development and widespread use of this surgical paradigm. For this reason, it is important to be able to train surgeons in the use of RAS procedures. RAS involves distinctive features that makes its learning different to other minimally invasive surgical procedures. One of these features is that the surgeons operate using a stereoscopic console. Therefore, it is necessary to perform RAS training stereoscopically. This article presents a mixed-reality (MR) tool for the stereoscopic visualization, annotation and collaborative display of RAS surgical procedures. The tool is an MR application because it can display real stereoscopic content and augment it with virtual elements (annotations) properly registered in 3D and tracked over time. This new tool allows the registration of surgical procedures, teachers (experts) and students (trainees), so that the teacher can share a set of videos with their students, annotate them with virtual information and use a shared virtual pointer with the students. The students can visualize the videos within a web environment using their personal mobile phones or a desktop stereo system. The use of the tool has been assessed by a group of 15 surgeons during a robotic-surgery master's course. The results show that surgeons consider that this tool can be very useful in RAS training.
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Affiliation(s)
- Sergio Casas-Yrurzum
- Institute of Robotics and Information Technology and Communication (IRTIC), University of Valencia, Valencia, Spain
| | - Jesús Gimeno
- Institute of Robotics and Information Technology and Communication (IRTIC), University of Valencia, Valencia, Spain
| | - Pablo Casanova-Salas
- Institute of Robotics and Information Technology and Communication (IRTIC), University of Valencia, Valencia, Spain
| | - Inma García-Pereira
- Institute of Robotics and Information Technology and Communication (IRTIC), University of Valencia, Valencia, Spain
| | - Eva García del Olmo
- General and Gastrointestinal Surgery, Fundación Investigación Consorcio Hospital General Universitario de Valencia (FIHGUV), Valencia, Spain
| | - Antonio Salvador
- General and Gastrointestinal Surgery, Fundación Investigación Consorcio Hospital General Universitario de Valencia (FIHGUV), Valencia, Spain
| | - Ricardo Guijarro
- Thoracic Surgery, Fundación Investigación Consorcio Hospital General Universitario de Valencia (FIHGUV), Valencia, Spain
| | - Cristóbal Zaragoza
- General and Gastrointestinal Surgery, Fundación Investigación Consorcio Hospital General Universitario de Valencia (FIHGUV), Valencia, Spain
| | - Marcos Fernández
- Institute of Robotics and Information Technology and Communication (IRTIC), University of Valencia, Valencia, Spain
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Sinha A, West A, Vasdev N, Sooriakumaran P, Rane A, Dasgupta P, McKirdy M. Current practises and the future of robotic surgical training. Surgeon 2023; 21:314-322. [PMID: 36932015 DOI: 10.1016/j.surge.2023.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION This study reviews the current state of robotic surgery training for surgeons, including the various curricula, training methods, and tools available, as well as the challenges and limitations of these. METHODS The authors carried out a literature search across PubMed, MEDLINE, and Google Scholar using keywords related to 'robotic surgery', 'computer-assisted surgery', 'simulation', 'virtual reality', 'surgical training', and 'surgical education'. Full text analysis was performed on 112 articles. TRAINING PROGRAMMES The training program for robotic surgery should focus on proficiency, deliberation, and distribution principles. The curricula can be broadly split up into pre-console and console-side training. Pre-Console and Console-Side Training: Simulation training is an important aspect of robotic surgery training to improve technical skill acquisition and reduce mental workload, which helps prepare trainees for live procedures. OPERATIVE PERFORMANCE ASSESSMENT The study also discusses the various validated assessment tools used for operative performance assessments. FUTURE ADVANCES Finally, the authors propose potential future directions for robotic surgery training, including the use of emerging technologies such as AI and machine learning for real-time feedback, remote mentoring, and augmented reality platforms like Proximie to reduce costs and overcome geographic limitations. CONCLUSION Standardisation in trainee performance assessment is needed. Each of the robotic curricula and platforms has strengths and weaknesses. The ERUS Robotic Curriculum represents an evidence-based example of how to implement training from novice to expert. Remote mentoring and augmented reality platforms can overcome the challenges of high equipment costs and limited access to experts. Emerging technologies offer promising advancements for real-time feedback and immersive training environments, improving patient outcomes.
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Affiliation(s)
- Ankit Sinha
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK.
| | - Alexander West
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK.
| | - Nikhil Vasdev
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK; University of Hertfordshire, School of Life and Medical Sciences, Hatfield, Hertfordshire, UK.
| | | | - Abhay Rane
- East Surrey Hospital, Redhill, Surrey, UK.
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, London, UK.
| | - Michael McKirdy
- Royal College of Physicians and Surgeons of Glasgow, Glasgow, UK.
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Burke JR, Fleming CA, King M, El-Sayed C, Bolton WS, Munsch C, Harji D, Bach SP, Collins JW. Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum. J Robot Surg 2023; 17:1443-1455. [PMID: 36757562 PMCID: PMC9909133 DOI: 10.1007/s11701-022-01518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/31/2022] [Indexed: 02/10/2023]
Abstract
Robot-assisted surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational stakeholders guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee. The study was conducted in four Phases: P1: a steering group was formed to review current literature and summarise the evidence, P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to the three round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. There was 100% response from all three rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of > 0.8. There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment. Using the Delphi methodology, we achieved multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC. This guidance will benefit from further validation following implementation.
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Affiliation(s)
- Joshua Richard Burke
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Christina A. Fleming
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- The Royal College of Surgeons, Dublin, Ireland
| | - Martin King
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Craigavon Area Hospital, Craigavon, Northern Ireland
| | - Charlotte El-Sayed
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | | | - Chris Munsch
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
| | - Deena Harji
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon P. Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Justin W. Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), UK, University College London, London, UK
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10
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Sighinolfi MC, Terzoni S, Scanferla E, Bianchi PP, Formisano G, Piccolo G, Barabino M, Pisani A, Salaj A, Gaia G, Marconi AM, Turri F, Sangalli M, Centanni S, Stocco M, Chiumello D, Assumma S, Sarchi L, Calcagnile T, Panio E, Grasso A, Dell'Orto P, Mariani NM, Verrusio C, Baisi A, Bozzini G, Rocco B. Prior Robotic Console Expertise May Improve Basic Skills at the New Hugo RAS Simulator: Results from a Cohort Trial and Implications for Skill Transference Across Platforms. EUR UROL SUPPL 2023; 53:83-89. [PMID: 37441345 PMCID: PMC10334229 DOI: 10.1016/j.euros.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Robot-assisted surgery ensures minimal invasiveness; since the expiry of the Da Vinci patent, new robotic systems have entered the market. Recently, the Hugo RAS received CE approval for several surgical procedures. However, more is needed to know about skill acquisition at the new simulator. Objective This study aims to analyse the factors impacting basic surgical skills at the Hugo RAS simulator. Design setting and participants We present a cross-sectional study involving 71 participants of different backgrounds invited to a hands-on session with the Hugo RAS simulator voluntarily. All of them had no prior expertise with the system. Participants were recruited among medical/nurse students, residents, and laparoscopic and robotic surgeons. Intervention All participants underwent a hands-on "pick and place" exercise at the Hugo RAS simulator; the metrics of a second-round pick and place exercise were recorded. Outcome measurements and statistical analysis Metrics were analysed with regard to the following variables: demographics, videogame use, and prior surgical experience (no surgical expertise, experience with laparoscopy, and experience with robotic console). Results and limitations All participants completed the test. Of them, 77.5% were naïve to surgery, 8.5% had prior laparoscopic expertise, and 14.1% had prior robotic console experience. The time to complete the pick and place exercise was significantly lower (p < 0.001) among prior robotic surgeons (38 s, interquartile range [IQR] 34-45) compared with both naïve participants (61 s, IQR 53-71) and laparoscopists (93 s, IQR 53-162). The overall score of the exercise decreased with age (p = 0.046); however, the overall scores were significantly and steadily higher among surgeons experienced in robotic consoles across all age groups (p = 0.006). Neither gender (p = 0.7) nor videogame use (p = 0.9) correlated significantly with the metrics. Conclusions This is the first study analysing factors impacting basic skill acquisition at a new robotic simulator. Experience with robotic consoles may represent a major factor, raising the hypothesis of the transferability of basic robotic skills across different robotic systems. Further studies are required to explore this issue. Patient summary In the present study, we analysed which characteristics may affect the basic surgical skills at a novel robotic platform.
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Affiliation(s)
- Maria Chiara Sighinolfi
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Scanferla
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | - Gaetano Piccolo
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Matteo Barabino
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Andrea Pisani
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Adelona Salaj
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Filippo Turri
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Mattia Sangalli
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Stefano Centanni
- ASST Santi Paolo and Carlo, Milan, Italy
- Department of Health Sciences, La Statale University of Milan, Milan, Italy
| | - Matteo Stocco
- ASST Santi Paolo and Carlo, Milan, Italy
- Department of Health Sciences, La Statale University of Milan, Milan, Italy
| | - Davide Chiumello
- Unit of Anesthesiology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Simone Assumma
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Luca Sarchi
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Tommaso Calcagnile
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Enrico Panio
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Angelica Grasso
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Paolo Dell'Orto
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | - Alessandro Baisi
- Unit of Thoracic Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Bernardo Rocco
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
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11
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Kalinov T, Georgiev T, Bliznakova K, Zlatarov A, Kolev N. Assessment of students' satisfaction with virtual robotic surgery training. Heliyon 2023; 9:e12839. [PMID: 36699266 PMCID: PMC9868440 DOI: 10.1016/j.heliyon.2023.e12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Objective Nowadays, in Bulgaria there is a trend of increasing entry into the surgical field of robot-assisted surgery operations, which suggests a need for the establishment of a large number of specialists in this field in a short period. Based on these arguments, the Medical University of Varna was the first university in the country to introduce a robotic surgery training program for medical students. The study aims to investigate the medical students' satisfaction on robotic surgery training provided at Medical University of Varna with da Vinci Skills Simulator. Design During the summer semester of the academic 2020/2021 and 2021/2022 years, a pilot training of robotic surgery was conducted with 5th year students in Medicine. Within one month, the students had the opportunity to get acquainted with the simulator of da Vinci Xi robotic system. The training was divided into two modules: a two-week theoretical module and a two-week practical module. After completing the training, students filled out a questionnaire dedicated to assess their satisfaction with the proposed training. Correlation between their responses and the objective parameters assessed on the simulator was calculated. Results Thirty participants (16 men and 14 women) shared their opinion on easiness of use and usefulness of the robotic simulator in training of surgery activities. Students' responses highly evaluated both aspects with average five-point Likert scale scores of 4.3 and 4.5, respectively. 93% of the participants would continue their further education and training in robotic surgery field. In addition, there was no correlation between objective evaluation by the simulator and students responses. Conclusions Training in robotic surgery proves to be a useful approach for training students to develop skills and profession in the field of surgery. The results suggest that training in this field may be accomplished even at the student level, by exploiting the robotic surgery in realistic scenario and thus, in a timely manner to find out the surgical direction they want to be further evolved.
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Affiliation(s)
- T. Kalinov
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
| | - T. Georgiev
- Department of Medical Devices, Electronic and Information Technologies in Healthcare, Medical University, Varna, Bulgaria
| | - K. Bliznakova
- Department of Medical Devices, Electronic and Information Technologies in Healthcare, Medical University, Varna, Bulgaria,Corresponding author.
| | - A. Zlatarov
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
| | - N. Kolev
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
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12
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Larkins KM, Mohan HM, Gray M, Costello DM, Costello AJ, Heriot AG, Warrier SK. Transferability of robotic console skills by early robotic surgeons: a multi-platform crossover trial of simulation training. J Robot Surg 2022; 17:859-867. [DOI: 10.1007/s11701-022-01475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
AbstractRobotic surgical training is undergoing a period of transition now that new robotic operating platforms are entering clinical practice. As this occurs, training will need to be adapted to include strategies to train across various consoles. These new consoles differ in multiple ways, with some new vendors using flat screen open source 3D enhanced vision with glasses and differences in design will require surgeons to learn new skills. This process has parallels with aviation credentialling across different aircraft described as type rating. This study was designed to test the hypothesis that technical robotic console operating skills are transferrable across different robotic operating platforms. Ten participants sequentially completed four Mimic®(Surgical Science) simulation exercises on two different robotic operating platforms (DaVinci®, Intuitive Surgical and HUGO™ RAS, Medtronic). Ethical approval and informed consent were obtained for this study. Groups were balanced for key demographics including previous robotic simulator experience. Data for simulation metrics and time to proficiency were collected for each attempt at the simulated exercise and analysed. Qualitative feedback on multi-platform learning was sought via unstructured interviews and a questionnaire. Participants were divided into two groups of 5. Group 1 completed the simulation exercises on console A first then repeated these exercises on console B. Group 2 completed the simulated exercises on console B first then repeated these exercises on console A. Group 1 candidates adapted quicker to the second console and Group 2 candidates reached proficiency faster on the first console. Participants were slower on the second attempt of the final exercise regardless of their allocated group. Quality and efficiency metrics and risk and safety metrics were equivalent across consoles. The data from this investigation suggests that console operating skills are transferrable across different platforms. Overall risk and safety metrics are within acceptable limits regardless of the order of progression of console indicating that training can safely occur across multiple consoles contemporaneously. This data has implications for the design of training and certification as new platforms progress to market and supports a proficiency-based approach.
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13
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Nathan A, Patel S, Georgi M, Fricker M, Asif A, Ng A, Mullins W, Hang MK, Light A, Nathan S, Francis N, Kelly J, Collins J, Sridhar A. Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a randomised, prospective, cross-over, effectiveness study. J Robot Surg 2022; 17:629-635. [PMID: 36253574 PMCID: PMC9576128 DOI: 10.1007/s11701-022-01467-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. The virtual classroom is comprised of a studio with multiple audio–visual inputs to which participants can connect remotely via the BARCO weConnect platform. Eleven novice surgical trainees were randomly allocated to two training groups (A and B). In week 1, both groups completed a robotic skills induction. In week 2, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week 3, the groups received the alternate intervention. The primary outcome was measured using the validated robotic-objective structured assessment of technical skills (R-OSAT) at the end of week 2 (time-point 1) and 3 (time-point 2). All participants completed the training curriculum and were included in the final analyses. At time-point 1, Group A achieved a statistically significant greater mean proficiency score compared to Group B (44.80 vs 35.33 points, p = 0.006). At time-point 2, there was no significant difference in mean proficiency score in Group A from time-point 1. In contrast, Group B, who received further adjunctive VCT showed significant improvement in mean proficiency by 9.67 points from time-point 1 (95% CI 5.18–14.15, p = 0.003). VCT is an effective, accessible training adjunct to self-directed robotic skills training. With the steep learning curve in robotic surgery training, VCT offers interactive, expert-led learning and can increase training effectiveness and accessibility.
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Affiliation(s)
- Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK. .,Royal College of Surgeons of England, London, UK. .,University College London Hospitals NHS Foundation Trust, London, UK.
| | - Sonam Patel
- University College London Medical School, London, UK
| | - Maria Georgi
- University College London Medical School, London, UK
| | | | - Aqua Asif
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alexander Ng
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Medical School, London, UK
| | | | - Man Kien Hang
- University College London Medical School, London, UK
| | - Alexander Light
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Senthil Nathan
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Nader Francis
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Justin Collins
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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14
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Britton CR, Francis I, Tay LJ, Krishnamoothy B. The role of the bedside assistant in robot-assisted surgery: A critical synthesis. J Perioper Pract 2022; 32:208-225. [PMID: 35592944 DOI: 10.1177/17504589221094136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics. AIM To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom. METHODS Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence. RESULTS Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence. CONCLUSION The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
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Affiliation(s)
| | - Indu Francis
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Li June Tay
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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