1
|
Brian R, Murillo A, Oh DS, Chern H, O'Sullivan PS. Comparing observed and preferred instruction in robotic surgery. Surgery 2024; 176:1072-1078. [PMID: 39043544 DOI: 10.1016/j.surg.2024.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/24/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The unique setup of robotic surgery challenges the traditional instructional dynamic between surgical learners and teachers. Previous studies have posited difficulties such as reliance on observational learning and ease of takeover. However, we lack understanding of how these instructional challenges manifest and are perceived by learners. Improving instruction has the potential to optimize education and performance in robotic surgery. METHODS In this qualitative study, we conducted robotic case observations and learner interviews focusing on instruction in robotic surgery. We deductively generated codes in a theory-informed manner after review of the instructional literature in surgery, medicine, and other fields. We applied these codes in a rigorous directed content analysis of field notes and transcripts to identify themes. RESULTS Thirty-eight faculty, fellows, and residents participated in 10 robotic cases and 20 semistructured interviews. Observed practices on the basis of case observations differed substantially from preferred practices on the basis of interview data. Using 37 codes, we identified 4 main themes related to instruction in robotic surgery: contextualization, individualization, autonomy, and multimodality. We contrasted observed and preferred instruction in each of these areas to generate instructional considerations that may better align preferences and practices. CONCLUSIONS We observed several suboptimal instructional practices that contradicted preferred ways of learning. We suggested robotic-specific instructional considerations such as using multimodality to promote active learning and to reduce ambiguity. We also provided considerations applicable to all types of surgery, such as to include rationale to promote learning consolidation and to frame operative steps to allow trainees to plan their participation.
Collapse
Affiliation(s)
- Riley Brian
- Department of Surgery, University of California, San Francisco, San Francisco CA.
| | - Alyssa Murillo
- Department of Surgery, University of California, San Francisco, San Francisco CA
| | - Daniel S Oh
- Department of Surgery, University of Southern California, Los Angeles, CA; Intuitive Surgical, Sunnyvale, CA
| | - Hueylan Chern
- Department of Surgery, University of California, San Francisco, San Francisco CA
| | | |
Collapse
|
2
|
Stockheim J, Andriof S, Andric M, Al-Madhi S, Acciuffi S, Franz M, Lorenz E, Peglow S, Benedix F, Perrakis A, Croner RS. The training pathway for residents: 'Robotic Curriculum for young Surgeons' (RoCS) does not impair patient outcome during implementation into clinical routine. J Robot Surg 2024; 18:307. [PMID: 39105995 PMCID: PMC11303422 DOI: 10.1007/s11701-024-02056-9] [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: 06/28/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
The "Robotic Curriculum for young Surgeons" (RoCS) was launched 03/2020 to address the increasing importance of robotics in surgical training. It aims to provide residents with foundational robotic skills by involving them early in their training. This study evaluated the impact of RoCS' integration into clinical routine on patient outcomes. Two cohorts were compared regarding the implementation of RoCS: Cohort 1 (before RoCS) included all robot-assisted procedures between 2017 and 03/2020 (n = 174 adults) retrospectively; Cohort 2 (after RoCS) included all adults (n = 177) who underwent robotic procedures between 03/2020 and 2021 prospectively. Statistical analysis covered demographics, perioperative parameters, and follow-up data, including mortality and morbidity. Subgroup analysis for both cohorts was organ-related (upper gastrointestinal tract (UGI), colorectal (CR), hepatopancreaticobiliary system (HPB)). Sixteen procedures were excluded due to heterogeneity. In-hospital, 30-, 90-day morbidity and mortality showed no significant differences between both cohorts, including organ-related subgroups. For UGI, no significant intraoperative parameter changes were observed. Surgery duration decreased significantly in CR and HPB procedures (p = 0.018 and p < 0.001). Estimated blood loss significantly decreased for CR operations (p = 0.001). The conversion rate decreased for HPB operations (p = 0.005). Length of hospitalization decreased for CR (p = 0.015) and HPB (p = 0.006) procedures. Oncologic quality, measured by histopathologic R0-resections, showed no significant changes. RoCS can be safely integrated into clinical practice without compromising patient safety or oncologic quality. It serves as an effective training pathway to guide robotic novices through their first steps in robotic surgery, offering promising potential for skill acquisition and career advancement.
Collapse
Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany.
| | - S Andriof
- Medical Faculty, University Magdeburg, Magdeburg, Germany
| | - M Andric
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Al-Madhi
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Acciuffi
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - M Franz
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - E Lorenz
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Peglow
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - F Benedix
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - A Perrakis
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - R S Croner
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
3
|
Kim SS, Mitzman B, Lui NS, Rochefort M, D'Souza D, Sancheti M, Manerikar A, Logan C, Yang S. Robotic Surgery in Thoracic Training Programs: A National Needs Assessment. Ann Thorac Surg 2024:S0003-4975(24)00585-X. [PMID: 39067629 DOI: 10.1016/j.athoracsur.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/05/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Cardiothoracic surgical trainees perceive a need for more instruction and exposure to robotic-assisted thoracoscopic surgery during their training. We sought to assess use and trainee exposure to robotic surgery in thoracic residency programs to identify areas for improvement. METHODS A voluntary electronic survey of 10 questions was distributed to surgeons working in all thoracic surgery residency programs in the United States. The survey asked respondents to provide the size of the residency, the availability and use of robots, and the trainee's adoption of robotic surgery in their practice after graduation. Multivariable logistic regression was performed. RESULTS Of a total of 76 cardiothoracic surgery training programs, surgeons from 69 training programs (90.8%) completed the survey. Most pulmonary lobectomy was performed using robotic surgery (55%). Approximately half of the training programs (35 of 69) have a formal robotic curriculum for the residents. Of 121 thoracic track trainees, 118 (97.5%) performed robotic surgery as part of their practice, whereas 62 of 110 (56.4%) cardiothoracic track and 16 of 158 (10.1%) cardiac track trainees performed robotic surgery. In a multivariate analysis, the adoption of robotic surgery was associated with having an established robotic training curriculum (odds ratio, 5.82; 95% CI, 1.32-35.7) and a larger training program (odds ratio, 3.78; 95% CI, 1.34-10.6). CONCLUSIONS A disparity exists in robotic surgical training among the training programs. A standardized curriculum and formal case requirements may be needed to ensure optimal preparation for future graduates.
Collapse
Affiliation(s)
- Samuel S Kim
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Natalie S Lui
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Matthew Rochefort
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Desmond D'Souza
- Division of Thoracic Surgery, Ohio State University Medical Center, Columbus, Ohio
| | - Manu Sancheti
- Division of Thoracic Surgery, Emory University Medical Center, Atlanta, Georgia
| | - Adwaiy Manerikar
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Charles Logan
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephen Yang
- Division of Thoracic Surgery, Johns Hopkins University Medical Center, Baltimore, Maryland
| |
Collapse
|
4
|
Clermidy H, Fadel G, Bottet B, Belaroussi Y, Eid M, Armand E, Baste JM, Pages PB, Fourdrain A, Al Zreibi C, Madelaine L, Saiydoun G. Robotic-assisted thoracic surgery training in France: a nation-wide survey from young surgeons. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae115. [PMID: 38889287 PMCID: PMC11219244 DOI: 10.1093/icvts/ivae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/26/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Evaluate theoretical and practical training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) in France. METHODS A survey was distributed to thoracic surgeons-in-training in France from November 2022 to February 2023. RESULTS We recruited 101 thoracic surgeons-in-training (77% response rate). Over half had access to a surgical robotics system at their current institution. Most (74%) considered robotic surgery training essential, 90% had attended a robotic procedure. Only 18% had performed a complete thoracic robotic procedure as the main operator. A complete RATS procedure was performed by 42% of fellows and 6% of residents. Of the remaining surgeons, 23% had performed part of a robotic procedure. Theoretical courses and simulation are well developed; 72% of residents and 91% of fellows had undergone simulation training in the operating room, at training facilities, or during congress amounting to <10 h (for 73% of the fellows and residents), 10-20 h (17%), 20-30 h (8%) or >30 h (3%). Access to RATS was ≥1 day/week in 71% of thoracic departments with robotic access. Fellows spent a median of 2 (IQR 1-3) semesters in departments performing robotic surgery. Compared with low-volume centres, trainees at high-volume centres performed significantly more complete robotic procedures (47% vs 13%; P = 0.001), as did fellows compared with residents. CONCLUSIONS Few young surgeons perform complete thoracic robotic procedures during practical training, and access remains centre dependent. Opportunities increase with seniority and exposure; however, increasing availability of robotic devices, theoretical formation, and simulation courses will increase opportunities.
Collapse
Affiliation(s)
- Hugo Clermidy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
| | - Guillaume Fadel
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Benjamin Bottet
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | - Yaniss Belaroussi
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Thoracic Surgery, Haut-Leveque Hospital, University of Bordeaux, Bordeaux, France
| | - Maroua Eid
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Cardiac Surgery, University of Angers, Angers, France
| | - Elsa Armand
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, North Hospital, Marseille, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France
| | - Pierre-Benoit Pages
- Cardiovascular and Thoracic Surgery Department, Dijon University Hospital, Dijon, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Lung Transplantation and Esophageal Diseases, North Hospital, Marseille, France
| | - Charles Al Zreibi
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Thoracic Surgery, Georges Pompidou European Hospital APHP, Paris, France
| | - Leslie Madelaine
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Cardiovascular and Thoracic Surgery Department, Dijon University Hospital, Dijon, France
| | - Gabriel Saiydoun
- Association of Thoracic and Cardiovascular Surgeon in Training, Association des Jeunes Chirurgiens Thoracique et Cardio-Vasculaire, Paris, France
- Department of Cardiac Surgery, Pitié Salpétrière University Hospital, Sorbonne University, APHP, Paris, France
- Department of Cardiac Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| |
Collapse
|
5
|
Wang TN, Woelfel IA, Huang E, Pieper H, Meara MP, Chen X(P. Behind the pattern: General surgery residsent autonomy in robotic surgery. Heliyon 2024; 10:e31691. [PMID: 38841510 PMCID: PMC11152925 DOI: 10.1016/j.heliyon.2024.e31691] [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: 06/13/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Robotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents' opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). Methods General surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2-5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. Results Resident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons' perceived operative time pressure inversely affected resident ICT. Conclusions This study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.
Collapse
Affiliation(s)
- Theresa N. Wang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Ingrid A. Woelfel
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Emily Huang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Heidi Pieper
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Michael P. Meara
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | | |
Collapse
|
6
|
Wahlstedt ER, Kronstedt SM, Saffati G, Hinojosa-Gonzalez DE, Mucher ZR. Overview of Robotic Surgery in the U.S. Military: From Conception to Utilization, and Future Applications. Mil Med 2024:usae222. [PMID: 38771002 DOI: 10.1093/milmed/usae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
This column explores the inception, challenges, and prospects of robotic surgery in the military. It highlights the military's role in developing early prototypes, current utilization, training struggles, partnerships with civilian organizations, and potential future applications. The military's influence on the evolving landscape of robotic surgery is emphasized.
Collapse
Affiliation(s)
- Eric R Wahlstedt
- College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Shane M Kronstedt
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gal Saffati
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Zachary R Mucher
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA
| |
Collapse
|
7
|
Harrison W, Munien K, Desai D. Robotic surgery education in Australia and New Zealand: primetime for a curriculum. ANZ J Surg 2024; 94:30-36. [PMID: 38196282 DOI: 10.1111/ans.18843] [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: 09/17/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Globally, robotic surgery (RS) has witnessed remarkable growth, yet Australia and New Zealand (ANZ) lack dedicated RS training programs, creating a workforce gap. This narrative review synthesises international research to explore trends and challenges in robotic education. METHODS We conducted a comprehensive literature review, searching PubMed, Google Scholar, and MEDLINE using keywords like 'robotic surgery', 'surgical education', 'robotic surgery training', and 'robotic surgery curriculum'. We selected studies contributing to understanding current curricula, training tools, and issues in robotic education, utilising the international experience and how it might apply to the ANZ context. RESULTS RS in ANZ has grown significantly over two decades, but formal curricula for trainees are absent. North America and Europe employ diverse training tools and curricula. Barriers include cost, access, time constraints, equipment complexity, changing training environments, and competition from emerging robotic surgical systems. Balancing the curriculum's demands with trainees' existing requirements is essential. CONCLUSION Developing a tailored RS curriculum within ANZ's surgical training is crucial for RS to become the primary surgical approach in the future. By working towards a national curriculum we can prepare skilled trainees in robotics to meet the rising demand. The most significant barrier is the lack of robotics in public hospital where trainees are based. This curriculum should encompass online teaching modules, bedside assistance, surgical simulation, dual console mentoring, and primary operator experience.
Collapse
Affiliation(s)
- William Harrison
- Department of Urology, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Kale Munien
- Department of Urology, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Devang Desai
- Department of Urology, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, Griffith University, Mount Gravatt, Queensland, Australia
- Faculty of Medicine, University of Southern Queensland, Darling Heights, Queensland, Australia
- Department of Urology, St Andrew's Toowoomba Hospital, Rockville, Queensland, Australia
- Department of Urology, St Vincent's Private Hospital Toowoomba, East Toowoomba, Queensland, Australia
- Department of Urology, Toowoomba Specialists, East Toowoomba, Queensland, Australia
| |
Collapse
|
8
|
Newland JJ, Sundel MH, Blackburn KW, Cairns CA, Cooper LE, Stewart SJ, Roque DM, Siddiqui MM, Brown RF. Early Implementation of Robotic Training in Surgical and Surgical Subspecialty Residency. Am Surg 2024:31348241229631. [PMID: 38262961 DOI: 10.1177/00031348241229631] [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: 01/25/2024]
Abstract
BACKGROUND Robotic surgery has emerged as an operative tool for many elective and urgent surgical procedures. The purpose of this study was to evaluate early surgical trainees' experiences and opinions of robotic surgery. METHODS An introductory robotic training course consisting of online da Vinci Xi/X training and in-person, hands on training was implemented for residents and medical students across surgical subspecialties at a single institution. A voluntary survey evaluating perceptions of and interest in robotic surgery and prior robotic surgery experience, as well as a basics of robotics quiz, was distributed to participants prior to the start of the in-person session. Descriptive statistics were used to evaluate the cohort. RESULTS 85 trainees participated in the course between 2020 and 2023, including 58 first- and second-year surgical residents (general surgery, urology, OB/GYN, and thoracic surgery) and 27 fourth-year medical students. 9.4% of participants reported any formal robotic surgery training prior to the session, with only 19% of participants reporting robotic operative experience. 52% of the participants knew of and/or had completed the da Vinci online course modules prior to the scheduled training session. Participants unanimously (100%) agreed that robotic surgery should be implemented into surgical training. CONCLUSIONS There is rising enthusiasm for robotic surgery, yet early exposure and training remain infrequent and inconsistent amongst medical students and new surgical residents. A standardized introduction of multi-disciplinary robotic surgery training should be incorporated into medical school and/or early residency education to ensure surgical residents receive appropriate exposure and training to achieve competency.
Collapse
Affiliation(s)
- John J Newland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margaret H Sundel
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kyle W Blackburn
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cassandra A Cairns
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura E Cooper
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shelby J Stewart
- Department of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dana M Roque
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Rebecca F Brown
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Jeffery CS, Stewart KE, Hayhurst JL, Hall CM, Regner JL, Raines AR. Survey shows all surgical residents have exposure to robotic surgery yet no formalized curricula exist amongst programs: A Southwest Surgical Congress Survey. Am J Surg 2023; 226:878-881. [PMID: 37558517 DOI: 10.1016/j.amjsurg.2023.07.031] [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: 03/25/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Increased robotic surgery exposure during general surgery training occurs at many institutions without a formal education curriculum. Our study evaluates the current state of general surgery robotic training within programs represented by the Southwestern Surgical Congress (SWSC). METHODS A web-based survey regarding robot-assisted surgery (RAS) and general surgery training was developed and sent to member institutions of the SWSC. General surgery program directors were asked to voluntarily complete the survey. Results were evaluated in aggregate. Descriptive analysis was used. RESULTS In total, 28 programs responded. All reported resident exposure to RAS during training. Case mix was diverse with exposure to multiple general surgical subspecialties. 89% of programs reported the presence of a formal RAS curriculum, however, only 53% reported recognition of training completion. Case volumes also varied amongst programs with 46% of programs reporting residents logging 21-40 cases and 35% logging more than 40 cases in total. CONCLUSION Exposure to RAS among SWSC residency programs is ubiquitous, however, there is significant variation between programs in case volumes, case types, and elements of RAS curricula.
Collapse
Affiliation(s)
- Christopher S Jeffery
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Kenneth E Stewart
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Joseph L Hayhurst
- University of Oklahoma College of Medicine, Department of Surgery, 800 Stanton L. Young Blvd., Suite 9000, Oklahoma City, OK, 73104, USA.
| | - Chad M Hall
- Baylor Scott & White Health, Department of Surgery, 2401 S. 31st St, Temple, TX, 76508, USA.
| | - Justin L Regner
- Baylor Scott & White Health, Department of Surgery, 2401 S. 31st St, Temple, TX, 76508, USA.
| | - Alexander R Raines
- University of Oklaoma College of Medicine, Department of Surgery, 800Stanton L. Young Blvd, Ste 9000, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
10
|
Perry B, Howard K, Novotny NM, Iacco A, Ivascu F, Nguyen N. Identifying barriers to resident robotic console time in a general surgery residency through a targeted needs assessment. J Robot Surg 2023; 17:2783-2789. [PMID: 37717231 DOI: 10.1007/s11701-023-01711-x] [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: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
Robotic-assisted general surgery is experiencing exponential growth. Despite our institution's high volume, residents often graduate with inadequate console experience. Our aim was to identify the educational needs of residents and perceived barriers to residents' console time from both attendings and residents. Separate surveys were created and distributed to robotic surgery faculty and general surgery residents at our institution. Questions were a variety of modalities and focused on the robotic surgery experience at our institution, including barriers to resident console time from both attending surgeon and resident perspectives. Although residents' interest in robotic surgery exceeded that of open and laparoscopic surgery, confidence in their robotic skills was low compared to the other modalities. The top barriers to participating in robotic cases according to residents included minimal or no previous console time with the attending, lack of simulator time, and being required to perform bedside assistant duties. Faculty reported resident preparedness, prior robotic skill demonstration, simulator time, case complexity, and their own confidence as significant factors influencing resident console time. Using these results, we concluded that the design and implementation of a formal robotic surgery curriculum should incorporate simulation-based opportunities for residents to practice their skills, improve confidence, and increase console experience. In addition, simulation opportunities for faculty should also be considered to allow for improvement and maintenance of robotic surgical skills.
Collapse
Affiliation(s)
- Bradley Perry
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA
| | - Kathryn Howard
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA
| | - Nathan M Novotny
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA
| | - Anthony Iacco
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA
| | - Felicia Ivascu
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA
| | - Ngan Nguyen
- Department of Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, MI, USA.
- Department of Foundational Medical Studies and Department of Surgery, Oakland University William Beaumont School of Medicine, O'Dowd Hall, Room 454, 586 Pioneer Drive, Rochester, MI, 48309, USA.
| |
Collapse
|
11
|
Wang TN, Woelfel IA, Pieper H, Haisley KR, Meara MP, Chen XP. Is Robotic Console Time a Surrogate for Resident Operative Autonomy? JOURNAL OF SURGICAL EDUCATION 2023; 80:1711-1716. [PMID: 37296003 DOI: 10.1016/j.jsurg.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Robotic-assisted surgery is an increasing part of general surgery training, but resident autonomy on the robotic platform can be hard to quantify. Robotic console time (RCT), the percentage of time the resident controls the console, may be an appropriate measure of resident operative autonomy. This study aims to characterize the correlation between objective resident RCT and subjectively scored operative autonomy. METHODS Using a validated resident performance evaluation instrument, we collected resident operative autonomy ratings from residents and attendings performing robotic cholecystectomy (RC) and robotic inguinal hernia repair (IH) at a university-based general surgery program between 9/2020-6/2021. We then extracted RCT data from the Intuitive surgical system. Descriptive statistics, t-tests and ANOVA were performed. RESULTS A total of 31 robotic operations (13 RC, 18 IH) performed by 4 attending surgeons and 8 residents (4 junior, 4 senior) were matched and included. 83.9% of cases were scored by both attending and resident. The average RCT per case was 35.6%(95% CI 13.0%,58.3%) for junior residents (PGY 2-3) and 59.7%(CI 51.1%,68.3%) for senior residents (PGY 4-5). The mean autonomy evaluated by residents was 3.29(CI 2.85,3.73) out of a maximum score of 5, while the mean autonomy evaluated by attendings was 4.12(CI 3.68,4.55). RCT significantly correlated with subjective evaluations of resident autonomy (r=0.61, p=0.0003). RCT also moderately correlated with resident training level (r=0.5306, p<0.0001). Neither attending robotic experience nor operation type significantly correlated with RCT or autonomy evaluation scores. CONCLUSIONS Our study suggests that resident console time is a valid surrogate for resident operative autonomy in robotic cholecystectomy and inguinal hernia repair. RCT may be a valuable measure in objective assessment of residents' operative autonomy and training efficiency. Future investigation into how RCT correlates with subjective and objective autonomy metrics such as verbal guidance or distinguishing critical operative steps is needed to validate the study findings further.
Collapse
Affiliation(s)
- Theresa N Wang
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Ingrid A Woelfel
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Heidi Pieper
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kelly R Haisley
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael P Meara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaodong Phoenix Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
12
|
Burns HR, Dinis J, Ding Y, Buchanan EP. Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction. Semin Plast Surg 2023; 37:287-298. [PMID: 38098685 PMCID: PMC10718655 DOI: 10.1055/s-0043-1775888] [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: 12/17/2023]
Abstract
Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.
Collapse
Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob Dinis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
13
|
Clanahan JM, Yee A, Awad MM. Active control time: an objective performance metric for trainee participation in robotic surgery. J Robot Surg 2023; 17:2117-2123. [PMID: 37237112 DOI: 10.1007/s11701-023-01628-5] [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: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Trainee participation and progression in robotic general surgery remain poorly defined. Computer-assisted technology offers the potential to provide and track objective performance metrics. In this study, we aimed to validate the use of a novel metric-active control time (ACT)-for assessing trainee participation in robotic-assisted cases. Performance data from da Vinci Surgical Systems was retrospectively analyzed for all robotic cases involving trainees with a single minimally invasive surgeon over 10 months. The primary outcome metric was percent ACT-the amount of trainee console time spent in active system manipulations over total active time from both consoles. Kruskal-Wallis and Mann-Whitney U statistical tests were applied in analyses. A total of 123 robotic cases with 18 general surgery residents and 1 fellow were included. Of these, 56 were categorized as complex. Median %ACT was statistically different between trainee levels for all case types taken in aggregate (PGY1s 3.0% [IQR 2-14%], PGY3s 32% [IQR 27-66%], PGY4s 42% [IQR 26-52%], PGY5s 50% [IQR 28-70%], and fellow 61% [IQR 41-85%], p = < 0.0001). When stratified by complexity, median %ACT was higher in standard versus complex cases for PGY5 (60% vs. 36%, p = 0.0002) and fellow groups (74% vs. 47%, p = 0.0045). In this study, we demonstrated an increase in %ACT with trainee level and with standard versus complex robotic cases. These findings are consistent with hypotheses, providing validity evidence for ACT as an objective measurement of trainee participation in robotic-assisted cases. Future studies will aim to define task-specific ACT to guide further robotic training and performance assessments.
Collapse
Affiliation(s)
- Julie M Clanahan
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Mailstop 8109-22-9905, Campus Box 8109, St. Louis, MO, 63110-1093, USA.
| | - Andrew Yee
- Data and Analytics, Intuitive Surgical, Inc., Peachtree Corners, GA, 30092, USA
| | - Michael M Awad
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Mailstop 8109-22-9905, Campus Box 8109, St. Louis, MO, 63110-1093, USA
| |
Collapse
|
14
|
Wile RK, Brian R, Rodriguez N, Chern H, Cruff J, O'Sullivan PS. Home practice for robotic surgery: a randomized controlled trial of a low-cost simulation model. J Robot Surg 2023; 17:2527-2536. [PMID: 37531043 PMCID: PMC10492874 DOI: 10.1007/s11701-023-01688-7] [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: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379-381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379-381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.
Collapse
Affiliation(s)
- Rachel K Wile
- School of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Riley Brian
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Natalie Rodriguez
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Hueylan Chern
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| | - Jason Cruff
- Department of Obstetrics/Gynecology-Female Pelvic Medicine & Reconstructive Surgery, Marshfield Clinic Health System, Marshfield, WI, 54449, USA
| | - Patricia S O'Sullivan
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143, USA
| |
Collapse
|
15
|
Yim NH, Burns HR, Davis MJ, Selber JC. Robotic Plastic Surgery Education: Developing a Robotic Surgery Training Program Specific to Plastic Surgery Trainees. Semin Plast Surg 2023; 37:157-167. [PMID: 38444955 PMCID: PMC10911909 DOI: 10.1055/s-0043-1771026] [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: 03/07/2024]
Abstract
Over the past two decades, the surgical community has increasingly embraced robotic-assisted surgery (RAS) due to its potential to enhance accuracy and decrease surgical morbidity. Plastic surgery as a field has been historically slow to incorporate RAS, with lack of adequate training posing as one of the most commonly cited barriers. To date, robot technology has been utilized for various reconstructive procedures including flap elevation and inset, pedicle dissection, and microvascular anastomosis. As RAS continues to integrate within plastic surgery procedures, the need for a structured RAS curriculum designed for plastic surgery trainees is rising. This article delineates the essential components of a plastic surgery-specific RAS curriculum and outlines current training models and assessment tools utilized across surgical subspecialties to date.
Collapse
Affiliation(s)
- Nicholas H. Yim
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Matthew J. Davis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jesse C. Selber
- Department of Plastic Surgery, Corewell Health, Grand Rapids, Michigan
| |
Collapse
|
16
|
Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills. J Robot Surg 2023:10.1007/s11701-023-01540-y. [PMID: 36754922 DOI: 10.1007/s11701-023-01540-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci® Skills Simulator™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.
Collapse
|
17
|
Gonçalves MR, Novo de Matos J, Oliveira A, Marinho R, Cadime I, Carlos Alves P, Morales-Conde S, Sousa MCB. Robotic4all project: Results of a hands-on robotic surgery training program. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2023. [DOI: 10.1016/j.lers.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
18
|
Imai T, Amersi F, Tillou A, Chau V, Soukiasian H, Lin M. A Multi-Institutional Needs Assessment in the Development of a Robotic Surgery Curriculum: Perceptions From Resident and Faculty Surgeons. JOURNAL OF SURGICAL EDUCATION 2023; 80:93-101. [PMID: 36075804 DOI: 10.1016/j.jsurg.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The growing adoption of robotic-assisted surgery mandates residents must acquire robotic skills. No standardized curriculum for robotic surgery exists. Therefore, programs have developed their own curricula, which are often unstructured and based on resource availability. With this strategy programs may not adhere to scholarly approaches in curriculum development. We aimed to obtain a multi-institutional needs assessment to address training needs and identify integral components of a formalized robotic surgery curriculum. METHODS A 10-question survey was distributed to general surgery residents. A separate 7-question survey was sent to robotic faculty surgeons at 3 institutions. Survey questions queried demographics, opinions regarding robotic training, proficiency definitions, and identification of procedures and instructional strategies for a curriculum. Mann- Whitney U test and Fisher's exact test were performed to compare responses amongst residents and faculty. Spearman's correlation was used to identify relationships between experience or post-graduate year (PGY) with response selection. RESULTS Both residents and faculty believed robotic training should start in the PGY1 (55.1% vs 52%; p = 0.58). Faculty recognized robotic training to be more important compared to residents (84% vs 58.1%; p < 0.05). Both groups considered a minimum of 21 to 40 robotic cases to be sufficient exposure during training (p = 0.30). Cholecystectomy (82.4% vs 72%; p = 0.261), ventral hernia repair (89.2% vs 88%; p = 1.0), inguinal hernia repair (91.9% vs 92%; p = 1.0), and right colectomy (83.8% vs 80%; p = 0.7) were considered to be the most appropriate robotic procedures during training. Both groups concurred that bedside (91.9% vs 100%; p = 0.33) and console skills training (97.3% vs 100%; p = 1.0), small group simulation (94.6% vs 72% p = 0.005), and independent practice (87.8% vs 92% p = 0.73), were instructional strategies vital to a curriculum. Faculty considered online didactic modules (96% vs 59.5%; p < 0.05) to be more important, whereas residents favored small group experiences for fundamental skills (94.6% vs. 72%; p < 0.05) and procedure-based simulation (96% vs 64%; p < 0.05). CONCLUSIONS Our targeted needs assessment identified requisite components of a robotics curriculum, which are feasible and accepted by both residents and faculty. Medical educators can use this as a resource to develop a formal robotics training curriculum.
Collapse
Affiliation(s)
- Taryne Imai
- Department of Surgery, Cedars-Sinai Health Care System, Los Angeles, California.
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Health Care System, Los Angeles, California
| | - Areti Tillou
- Department of Surgery, University of California, Los Angeles, California
| | - Van Chau
- Department of Surgery, Cedars-Sinai Health Care System, Los Angeles, California
| | - Harmik Soukiasian
- Department of Surgery, Cedars-Sinai Health Care System, Los Angeles, California
| | - Matthew Lin
- Department of Surgery, University of California, San Francisco, California
| |
Collapse
|
19
|
Greenberg AL, Syed SM, Alseidi A, O’Sullivan PS, Chern H. Robotic training for medical students: feasibility of a pilot simulation curriculum. J Robot Surg 2022; 17:1029-1038. [DOI: 10.1007/s11701-022-01508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
AbstractWhile robotic procedures are growing rapidly, medical students have a limited role in robotic surgeries. Curricula are needed to enhance engagement. We examined feasibility of augmenting Intuitive Surgical (IS) robotic training for medical students. As a pilot, 18 senior students accepted an invitation to a simulation course with a daVinci robot trainer. Course teaching objectives included introducing robotic features, functionalities, and roles. A 1-h online module from the IS learning platform and a 4-h in-person session comprised the course. The in-person session included an overview of the robot by an IS trainer (1.5 h), skills practice at console (1.5 h), and a simulation exercise focused on the bedside assist role (1 h). Feasibility included assessing implementation and acceptability using a post-session survey and focus group (FG). Survey responses were compiled. FG transcripts were analyzed using inductive thematic analysis techniques. Fourteen students participated. Implementation was successful as interested students signed up and completed each of the course components. Regarding acceptability, students reported the training valuable and recommended it as preparation for robotic cases during core clerkships and sub-internships. In addition, FGs revealed 4 themes: (1) perceived expectations of students in the OR; (2) OR vs. outside-OR learning; (3) simulation of stress; and (4) opportunities to improve the simulation component. To increase preparation for the robotic OR and shift robotic training earlier in the surgical education continuum, educators should consider hands-on simulation for medical students. We demonstrate feasibility although logistics may limit scalability for large numbers of students.
Collapse
|
20
|
Quinn KM, Chen X, Runge LT, Pieper H, Renton D, Meara M, Collins C, Griffiths C, Husain S. The robot doesn't lie: real-life validation of robotic performance metrics. Surg Endosc 2022:10.1007/s00464-022-09707-8. [PMID: 36266482 DOI: 10.1007/s00464-022-09707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Degree of resident participation in a case is often used as a surrogate marker for operative autonomy, an essential element of surgical resident training. Previous studies have demonstrated a considerable disagreement between the perceptions of attending surgeons and trainees when it comes to estimating operative participation. The Da Vinci Surgical System dual console interface allows machine generated measurements of trainee's active participation, which has the potential to obviate the need for labor intensive direct observation of surgical procedures. However, the robotic metrics require validation. We present a comparison of operative participation as perceived by the resident, faculty, trained research staff observer (gold standard), and robotic machine generated data. METHODS A total of 28 consecutive robotic inguinal hernia repair procedures were observed by research staff. Operative time, percent active time for the resident, and number of handoffs between the resident and attending were recorded by trained research staff in the operating room and the Da Vinci Surgical System. Attending and resident evaluations of operative performance and perceptions of percent active time for the resident were collected using standardized forms and compared with the research staff observed values and the robot-generated console data. Wilcoxon two-sample tests and Pearson Correlation coefficients statistical analysis were performed. RESULTS Robotic inguinal hernia repair cases had a mean operative time of 91.3 (30) minutes and an attending-rated mean difficulty of 3.1 (1.26) out of 5. Residents were recorded to be the active surgeon 71.8% (17.7) of the total case time by research staff. There was a strong correlation (r = 0.77) in number of handoffs between faculty and trainee as recorded by the research staff and robot (4.28 (2.01) vs. 5.8 (3.04) respectively). The robotic machine generated data demonstrated the highest degree of association when compared to the gold standard (research staff observed data), with r = 0.98, p < 0.0001. Lower levels of association were seen with resident reported (r = 0.66) perceptions and faculty-reported (r = 0.55) perceptions of resident active operative time. CONCLUSIONS Our findings suggest that robot-generated performance metrics are an extremely accurate and reliable measure of intraoperative resident participation indicated by a very strong correlation with the data recorded by research staff's direct observation of the case. Residents demonstrated a more accurate awareness of their degree of participation compared with faculty surgeons. With high accuracy and ease of use, robotic surgical system performance metrics have the potential to be a valuable tool in surgical training and skill assessment.
Collapse
Affiliation(s)
- Kristen M Quinn
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St. Room CSB 417, Charleston, SC, 29425, USA.
| | - Xiaodong Chen
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Louis T Runge
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St. Room CSB 417, Charleston, SC, 29425, USA
| | - Heidi Pieper
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - David Renton
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Michael Meara
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Courtney Collins
- Division of Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Claire Griffiths
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Syed Husain
- Division of Colorectal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| |
Collapse
|
21
|
Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy. Tech Coloproctol 2022; 26:953-962. [DOI: 10.1007/s10151-022-02679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
|