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Harley F, Ruseckaite R, Fong E, Yao HH, Hashim H, O'Connell HE. Guidelines for robotic credentialling in reconstructive and functional urology. Consensus study. BJUI COMPASS 2025; 6:e467. [PMID: 39877580 PMCID: PMC11771499 DOI: 10.1002/bco2.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 11/02/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives This study aims to define criteria for robotic reconstructive and functional urology credentialing using expert consensus. A recent narrative review identified a lack of standardised minimal requirements for performing robotic-assisted surgery procedures. The substantial variability or absence of a standardised curriculum and credentialing process within a highly specialised surgical field is often insufficient to guarantee surgeon proficiency and could potentially jeopardise patient safety. Subjects and Methods Thirty-five international robotic surgery experts in urology and urogynaecology, selected based on surgical and research expertise, were invited to participate as expert panellists. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed list of recommendations that was identified from the literature and review of relevant international credentialing policies in three electronic survey rounds. Results Fourteen experts participated in round 1 of online surveys, 9 in round 2 and 13 in round 3. From 50 statements presented to the Delphi panel in round 1, a total of 39 recommendations (32 from round 1, 4 from round 2 and 3 from round 3) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Panellists agreed reconstructive and functional urology required its own specific modular training curriculum as the foundation for robotic training and a surgeon must have appropriate training i.e., fellowship or evidence of speciality training in functional urology. Conclusions This was the first study to develop preliminary guidelines on credentialing for robotic surgery in reconstructive and functional urology. A Delphi approach was employed to establish comprehensive credentialing criteria for robotic-assisted surgery. The consistent adoption of these criteria across institutions will foster the proficiency of robotic surgeons and has the potential to bring improvements in patient outcomes.
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Affiliation(s)
- Frances Harley
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rasa Ruseckaite
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Eva Fong
- Department of UrologyUrology InstituteAucklandNew Zealand
| | - Henry Han‐I Yao
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Hashim Hashim
- Bristol Urological InstituteSouthmead Hospital, North Bristol NHS TrustBristolUK
| | - Helen E. O'Connell
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Pai SN, Jeyaraman M, Jeyaraman N, Nallakumarasamy A, Yadav S. In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus 2023; 15:e43634. [PMID: 37719624 PMCID: PMC10504870 DOI: 10.7759/cureus.43634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Hospital for Orthopedics, Sports Medicine, Arthritis, and Trauma (HOSMAT) Hospital, Bangalore, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Khan MTA, Patnaik R, Lee CS, Willson CM, Demario VK, Krell RW, Laverty RB. Systematic review of academic robotic surgery curricula. J Robot Surg 2022; 17:719-743. [DOI: 10.1007/s11701-022-01500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
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Sundelin MO, Paltved C, Kingo PS, Kjölhede H, Jensen JB. The transferability of laparoscopic and open surgical skills to robotic surgery. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:26. [PMID: 36064750 PMCID: PMC9446560 DOI: 10.1186/s41077-022-00223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Within the last decades, robotic surgery has gained popularity. Most robotic surgeons have changed their main surgical activity from open or laparoscopic without prior formal robotic training. With the current practice, it is of great interest to know whether there is a transfer of surgical skills. In visualization, motion scaling, and freedom of motion, robotic surgery resembles open surgery far more than laparoscopic surgery. Therefore, our hypothesis is that open-trained surgeons have more transfer of surgical skills to robotic surgery, compared to surgeons trained in laparoscopy. METHODS Thirty-six surgically inexperienced medical students were randomized into three groups for intensive simulation training in an assigned modality: open surgery, laparoscopy, or robot-assisted laparoscopy. The training period was, for all study subjects, followed by performing a robot-assisted bowel anastomosis in a pig model. As surrogate markers of surgical quality, the anastomoses were tested for resistance to pressure, and video recordings of the procedure were evaluated by two blinded expert robotic surgeons, using a global rating scale of robotic operative performance (Global Evaluative Assessment of Robotic Skills (GEARS)). RESULTS The mean leak pressure of bowel anastomosis was 36.25 (7.62-64.89) mmHg in the laparoscopic training group and 69.01 (28.02-109.99) mmHg in the open surgery group, and the mean leak pressure for the robotic training group was 108.45 (74.96-141.94) mmHg. The same pattern was found with GEARS as surrogate markers of surgical quality. GEARS score was 15.71 (12.37-19.04) in the laparoscopic training group, 18.14 (14.70-21.58) in the open surgery group, and 22.04 (19.29-24.79) in the robotic training group. In comparison with the laparoscopic training group, the robotic training group had a statistically higher leak pressure (p = 0.0015) and GEARS score (p = 0.0023). No significant difference, for neither leak pressure nor GEARS, between the open and the robotic training group. CONCLUSION In our study, training in open surgery was superior to training in laparoscopy when transitioning to robotic surgery in a simulation setting performed by surgically naive study subjects.
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Affiliation(s)
- Maria Ordell Sundelin
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark. .,Corporate MidtSim, Central Denmark Region, Aarhus, Denmark.
| | | | - Pernille Skjold Kingo
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Grittner U, Bloomfield K, Kuntsche S, Callinan S, Stanesby O, Gmel G. Improving measurement of harms from others' drinking: Using item-response theory to scale harms from others' heavy drinking in 10 countries. Drug Alcohol Rev 2022; 41:577-587. [PMID: 34460976 PMCID: PMC8882707 DOI: 10.1111/dar.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/05/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The heavy drinking of others may negatively affect an individual on several dimensions of life. Until now, there is scarce research about how to judge the severity of various experiences of such harms. This study aims to empirically scale the severity of such harm items and to determine who is at most risk of these harms. METHODS We used population-based survey data from 10 countries of the GENAHTO project (Gender and Alcohol's Harms to Others, data collection: 2011-2016). Questions about harms from others' drinking asked about verbal and physical harm, damage of belongings, traffic accidents, harassment, threatening behaviour, family and financial problems. We used item response theory methods (IRT) to scale severity of the aforementioned items. To acknowledge culturally based variations in different countries, we assessed 'differential item functioning'. RESULTS The items 'family problems', 'financial problems' and 'clothes and property damage' as well as 'physical harm' were scaled as more severe in most countries compared to other items. Substantial differential item functioning was present in more than half of the country pairings. The item 'financial problems' was most often differentially scaled. Younger people who drank more, as well as women (compared to men), reported more harm. DISCUSSION AND CONCLUSIONS Using IRT, we were able to evaluate grades of severity in harms from others' drinking. IRT scaling yielded in similar rankings of items as reported from other studies. However, empirical scaling allows for more differentiated severity scaling than simple summary scores and is more sensitive to cultural differences.
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Affiliation(s)
- Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany, Berlin Institute of Health, Berlin, Germany
| | - Kim Bloomfield
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany, Berlin Institute of Health, Berlin, Germany, Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark., Health Promotion Department of Public Health, University of Southern Denmark, Esbjerg, Denmark, Alcohol Research Group, Public Health Institute, Emeryville, USA
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Oliver Stanesby
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland., Addiction Switzerland, Research Department, Lausanne, Switzerland., Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada., University of the West of England, Faculty of Health and Applied Science, Bristol, United Kingdom
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Validity of robotic simulation for high-stakes examination: a pilot study. J Robot Surg 2021; 16:409-413. [PMID: 34053018 DOI: 10.1007/s11701-021-01258-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
Simulation is increasingly being used to train surgeons and access technical competency in robotic skills. The construct validity of using simulation performance for high-stakes examinations such as credentialing has not been studied appropriately. There are data on how simulation exercises can differentiate between novice and expert surgeons, but there are limited data to support their use for distinguishing intermediate from competent surgeons. Senior cardiothoracic trainees with limited robotic but significant laparoscopic experience ("intermediate surgeons", IS) and practicing robotic thoracic surgeons ("competent surgeons", CS) participating in a thoracic cadaver robotic course were evaluated on three Da Vinci (Xi) simulations. Scores were separately recorded into components and analyzed by t-test for significant differences between groups. 21 competent and 17 intermediate surgeons participated. Overall scores did not have a statistically significant difference in any exercise between groups. Simulation exercises do not appear to distinguish intermediate from competent surgeon performance of robotic skills. Without better validity data, the use of simulation for credentialing should be thoughtfully considered.
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Are current credentialing requirements for robotic surgery adequate to ensure surgeon proficiency? Surg Endosc 2020; 35:2104-2109. [PMID: 32377839 DOI: 10.1007/s00464-020-07608-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Robotic surgery has seen unprecedented growth, requiring hospitals to establish or update credentialing policies regarding this technology. Concerns about verification of robotic surgeon proficiency and the adequacy of current credentialing criteria to maintain patient safety have arisen. The aim of this project was to examine existing institutional credentialing requirements for robotic surgery and evaluate their adequacy in ensuring surgeon proficiency. METHODS Robotic credentialing policies for community and academic surgery programs were acquired and reviewed. Common criteria across institutions related to credentialing and recredentialing were identified and the average, standard deviation, and range of numeric requirements, if defined, was calculated. Criteria for proctors and assistants were also analyzed. RESULTS Policies from 42 geographically dispersed US hospitals were reviewed. The majority of policies relied on a defined number of proctored cases as a surrogate for proficiency with an average of 3.24 ± 1.69 and a range of 1-10 cases required for initial credentialing. While 34 policies (81%) addressed maintenance of privileges requirements, there was wide variability in the average number of required robotic cases (7.19 ± 3.28 per year) and range (1-15 cases per year). Only 11 policies (26%) addressed the maximum allowable time gap between robotic cases. CONCLUSION Significant variability in credentialing policies exists in a representative sample of US hospitals. Most policies require completion of a robotic surgery training course and a small number of proctored cases; however, ongoing objective performance assessments and patient outcome monitoring was rarely described. Existing credentialing policies are likely inadequate to ensure surgeon proficiency; therefore, development and wide implementation of robust credentialing guidelines is recommended to optimize patient safety and outcomes.
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Robotic Thoracic Surgery Training for Residency Programs. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:417-422. [DOI: 10.1097/imi.0000000000000573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.
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Abstract
Background and Objectives: Robotic surgical programs are increasing in number. Efficient methods by which to monitor and evaluate robotic surgery teams are needed. Methods: Best practices for an academic university medical center were created and instituted in 2009 and continue to the present. These practices have led to programmatic development that has resulted in a process that effectively monitors leadership team members; attending, resident, fellow, and staff training; credentialing; safety metrics; efficiency; and case volume recommendations. Results: Guidelines for hospitals and robotic directors that can be applied to one's own robotic surgical services are included with examples of management of all aspects of a multispecialty robotic surgery program. Conclusion: The use of these best practices will ensure a robotic surgery program that is successful and well positioned for a safe and productive environment for current clinical practice.
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Affiliation(s)
| | | | | | | | - Jerome R Lyn-Sue
- Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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10
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Kowalewski KF, Schmidt MW, Proctor T, Pohl M, Wennberg E, Karadza E, Romero P, Kenngott HG, Müller-Stich BP, Nickel F. Skills in minimally invasive and open surgery show limited transferability to robotic surgery: results from a prospective study. Surg Endosc 2018; 32:1656-1667. [PMID: 29435749 DOI: 10.1007/s00464-018-6109-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited evidence on the transferability of conventional laparoscopic and open surgical skills to robotic-assisted surgery. The primary aim of this study was to evaluate the transferability of expertise in conventional laparoscopy and open surgery to robotic-assisted surgery using the da Vinci Skills Simulator (dVSS). Secondary aims included evaluating the influence of individual participants' characteristics. METHODS Participants performed four tasks on the dVSS: Peg Board 1 (PB), Pick and Place (PP), Thread the Rings (TR), and Suture Sponge 1 (SS). Participants were classified into three groups (Novice, Intermediate, Experts) according to experience in laparoscopic and open surgery. All tasks were performed twice except for SS. Performance was assessed using the built-in scoring system. RESULTS 37 medical students and 25 surgeons participated. Experts did not perform significantly better than less experienced participants on the dVSS. Specifically, with regard to laparoscopic experience, total simulator scores were: Novices 68.2 ± 28.8; Intermediates 65.1 ± 31.2; Experts 65.1 ± 30.0; p = 0.611. Regarding open surgical experience, scores were: Novices 68.6 ± 28.7; Intermediates 68.2 ± 30.8; Experts 63.2 ± 30.3; p = 0.305. Although there were some significant differences among groups for single parameters in specific tasks, there was no constant superiority of one group. Laparoscopic and open surgical Novices improved significantly in overall score and time for all three tasks (p < 0.05). Laparoscopic intermediates improved only in PP time (4.64 ± 3.42; p = 0.006), open Intermediates in PB score (11.98 ± 13.01; p = 0.025), and open Experts in PP score (6.69 ± 11.48; p = 0.048). Laparoscopic experts showed no improvement. Participants with gaming experience had better overall scores than non-gamers when comparing all second attempts (Gamer 83.62 ± 7.57; Non-Gamer 76.31 ± 12.78; p = 0.008) as well as first and second attempts together (Gamer 72.08 ± 8.86; Non-Gamer 65.45 ± 11.68; p = 0.039). Musical and sports experience showed no correlation with robotic performance. CONCLUSIONS Robotic-assisted surgery requires skills distinct from conventional laparoscopy or open surgery. Basic robotic skills training prior to patient contact should be required.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mona W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Erica Wennberg
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Emir Karadza
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philipp Romero
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Baldea KG, Thorwarth R, Bajic P, Quek ML, Gupta GN. Design and Implementation of a Robotic Surgery Training Experience Logging System. JOURNAL OF SURGICAL EDUCATION 2017; 74:1047-1051. [PMID: 28668549 DOI: 10.1016/j.jsurg.2017.06.002] [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: 12/10/2016] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Residents currently log robotic cases in the ACGME system as a "surgeon" if they performed any critical step of the procedure on the surgeon console. There is no standardization as to which steps or how much of the procedure should be performed by the resident. It was our objective to establish a tool for logging the true operative experience in robotic surgery to aid in assessing surgical competency as well as curriculum development. MATERIALS AND METHODS We propose a tool to log surgical skill progression, experience, and feedback for robotic cases. A web-based robotic experience logging system (RoboLog) was developed with procedures deconstructed to their major steps. Trainees may request the supervising attending review their performance. RoboLog provides automated summary reports to both residents and attendings. RESULTS RoboLog was successfully developed and piloted with a total of 310 cases logged over 1 year. A reporting structure was developed where residents could view statistics on several data points such as step-specific involvement and feedback from attending staff. Detailed data on resident experience were obtained. For instance, 82% of the 151 robotic prostatectomies were logged as "surgeon", yet urethral transection had <35% resident involvement. CONCLUSIONS Our current system for logging robotic experience is lacking given the fact that resident involvement on the surgical console is variable. Widespread usage of a logging system with more insight into step-specific involvement is needed. RoboLog fills this need and can be used to track robotic training progress and aid in development of a standardized curriculum.
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Affiliation(s)
- Kristin G Baldea
- Department of Urology, Loyola University Medical Center, Maywood, Illinois.
| | - Ryan Thorwarth
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Petar Bajic
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Andolfi C, Umanskiy K. Mastering Robotic Surgery: Where Does the Learning Curve Lead Us? J Laparoendosc Adv Surg Tech A 2017; 27:470-474. [DOI: 10.1089/lap.2016.0641] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ciro Andolfi
- Department of Surgery, the University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Konstantin Umanskiy
- Department of Surgery, the University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Carpenter BT, Sundaram CP. Training the next generation of surgeons in robotic surgery. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:39-44. [PMID: 30697562 PMCID: PMC6193443 DOI: 10.2147/rsrr.s70552] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Context Robotic surgery has been used with rapidly increasing frequency within urology and across many other surgical specialties. A standardized curriculum for the training and credentialing of robotic surgeons has unfortunately trailed far behind the adoption of this surgical technology. Objective To review the current available surgical skills training models, assessments, and curricula for the purpose of training resident, fellow, and practicing surgeons in an effort to promote surgical skill proficiency and mastery and to minimize the risk of patient harm. Evidence acquisition We performed a thorough review of available literature through a PubMed database search in February 2015. Evidence synthesis In this article, we compiled and scrutinized the available relevant literature regarding past and present robotic surgical training techniques and credentialing criteria. This review details the basic surgical skills (both technical and nontechnical) that are necessary for individuals and teams to be successful in the operative setting. We go on to discuss the role of current robotic surgical training techniques including dry lab and virtual simulators. Finally, we offer current validated training curricula, the Global Evaluative Assessment of Robotic Skills and Fundamentals of Robotic Surgery models, which have laid the groundwork for a future standardized model that could be applied on a national and international level and across several surgical subspecialties. The ultimate goal of the review is to provide a foundation from which a future standardized training and credentialing curriculum could be based. Conclusion There is currently a great need for a standardized curriculum to be developed and employed for the use of training and credentialing future and current robotic surgeons.
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Affiliation(s)
- Benjamin T Carpenter
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA,
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA,
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Yang K, Perez M, Hubert N, Hossu G, Perrenot C, Hubert J. Effectiveness of an Integrated Video Recording and Replaying System in Robotic Surgical Training. Ann Surg 2017; 265:521-526. [DOI: 10.1097/sla.0000000000001699] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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King N, Kunac A, Merchant AM. A Review of Endoscopic Simulation: Current Evidence on Simulators and Curricula. JOURNAL OF SURGICAL EDUCATION 2016; 73:12-23. [PMID: 26699281 DOI: 10.1016/j.jsurg.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
Upper and lower endoscopy is an important tool that is being utilized more frequently by general surgeons. Training in therapeutic endoscopic techniques has become a mandatory requirement for general surgery residency programs in the United States. The Fundamentals of Endoscopic Surgery has been developed to train and assess competency in these advanced techniques. Simulation has been shown to increase the skill and learning curve of trainees in other surgical disciplines. Several types of endoscopy simulators are commercially available; mechanical trainers, animal based, and virtual reality or computer-based simulators all have their benefits and limitations. However they have all been shown to improve trainee's endoscopic skills. Endoscopic simulators will play a critical role as part of a comprehensive curriculum designed to train the next generation of surgeons. We reviewed recent literature related to the various types of endoscopic simulators and their use in an educational curriculum, and discuss the relevant findings.
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Affiliation(s)
- Neil King
- Division of General Surgery, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey
| | - Anastasia Kunac
- Division of Trauma, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey
| | - Aziz M Merchant
- Division of General Surgery, Department of General Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey.
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Vetter MH, Green I, Martino M, Fowler J, Salani R. Incorporating resident/fellow training into a robotic surgery program. J Surg Oncol 2015; 112:684-9. [PMID: 26289120 DOI: 10.1002/jso.24006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 01/09/2023]
Abstract
With the rapid uptake of the robotic approach in gynecologic surgery, a thorough understanding of the technology, including its uses and limitations, is critical to maximize patient outcomes and safety. This review discusses the role of training modalities and development of curricula for robotic surgery. Furthermore, methods for incorporating the entire surgical team and the process of credentialing/maintaining privileges are described.
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Affiliation(s)
| | | | - Martin Martino
- University of South Florida, Allentown, Pennsylvania
- Lehigh Valley Health Network, Allentown, Pennsylvania
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Bahler CD, Sundaram CP. Towards a standardised training curriculum for robotic surgery. BJU Int 2015; 116:4-5. [PMID: 26123072 DOI: 10.1111/bju.13017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Clinton D Bahler
- Department of Urology, Indiana University, Indianapolis, IN, USA
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Sood A, Jeong W, Ahlawat R, Campbell L, Aggarwal S, Menon M, Bhandari M. Robotic surgical skill acquisition: What one needs to know? J Minim Access Surg 2015; 11:10-5. [PMID: 25598593 PMCID: PMC4290108 DOI: 10.4103/0972-9941.147662] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/22/2022] Open
Abstract
Robotic surgery has been eagerly adopted by patients and surgeons alike in the field of urology, over the last decade. However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Accordingly, in this review, we aim to highlight ‘who’ needs to learn ‘what’ and ‘how’, to become competent in robotic surgery. We demonstrate that both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. With regard to training curricula, a variety of training programs such as academic fellowships, mini-fellowships, and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons adequately. Fellowships provide the most comprehensive training, however, may not be suitable to all surgeon-learners secondary to the long-term time commitment. For these surgeon-learners short-term courses such as the mini-fellowships or mentored skill courses might be more apt. Lastly, with regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Logan Campbell
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Shruti Aggarwal
- Department of Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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