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Britton CR, Francis I, Tay LJ, Krishnamoothy B. The role of the bedside assistant in robot-assisted surgery: A critical synthesis. J Perioper Pract 2022; 32:208-225. [PMID: 35592944 DOI: 10.1177/17504589221094136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics. AIM To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom. METHODS Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence. RESULTS Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence. CONCLUSION The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
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Affiliation(s)
| | - Indu Francis
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Li June Tay
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lagrange F, Fiard G, Larose C, Eschwege P, Hubert J. Role and Training of the Bedside Surgeon in Robotic Surgery: A Survey Among French Urologists-in-Training. Res Rep Urol 2022; 14:17-22. [PMID: 35083180 PMCID: PMC8785127 DOI: 10.2147/rru.s344369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Due to the development of robotic surgery, surgeons operating at the console are physically separated from the patient. They must rely on help from an assistant, also called bedside surgeon. This study aimed to investigate the habits and practices of French urologic residents when performing this role and to determine whether they expected specific training to qualify as bedside surgeons. Materials and Methods A web-based survey was sent to French urology residents and fellows using the mailing-list of the French Association of Urologists in Training (AFUF). Results Over a 3-month period, 86 residents and fellows responded to the survey. Seventy-five (87.2%) thought that an experience as bedside surgeon was useful to acquire console surgeon status and, more specifically, 48.2% of them indicated that this former experience was vital. Nearly 64% considered that learning robotic surgery was essential during residency and fellowship. Overall, 91.9% believed that bedside surgeons should receive a formal training. They were 69.7% to need 5 to 10 procedures to feel confident as bedside surgeon. Almost 75% underwent laparoscopic training on simulators. Having access to a surgery school significantly increased the probability of receiving laparoscopic training on simulators (p = 0.0033). Conclusion French urology residents and fellows expect a specific training program for bedside surgeons to increase their level of confidence and to get familiar with the device during their first robotic procedures. For them, a bedside surgeon program on a regional/national level would be required.
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Affiliation(s)
- Francois Lagrange
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
- Correspondence: Francois Lagrange, Tel +33 83 15 31 52, Email
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, 38043, France
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, 38043, France
| | - Clement Larose
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
| | - Pascal Eschwege
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
| | - Jacques Hubert
- Department of Urology, University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
- IADI-UL-INSERM (U1254), University Hospital Nancy-Brabois, Vandœuvre-lès-Nancy, Nancy, 54511, France
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Grannan HR, Hetzel E, Goldblatt MI, Gould JC, Higgins RM. Robotic General Surgery Resident Training Curriculum: A Pilot Experience. Surg Laparosc Endosc Percutan Tech 2021; 31:588-593. [PMID: 33900227 DOI: 10.1097/sle.0000000000000942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to report the impact of a pilot robotic general surgery resident training curriculum. MATERIALS AND METHODS A single institution pilot robotic general surgery training curriculum was instituted in 2016. Accreditation Council for Graduate Medical Education operative case log trends, resident simulation performance, and surveys were analyzed. RESULTS Forty-three general surgery residents participated in the robotic surgery training curriculum, 2016 to 2019. In total, 161 robotic cases were logged, increasing each academic year. Residents acted as bedside assistant in 42.9% (n=69) and as console surgeon in 57.1% (n=92). Fifteen first-year residents were surveyed on the training curriculum. On the postcurriculum survey, 100% found the curriculum to be very helpful, notably the hands-on in-service and skills simulator. CONCLUSIONS Since the curriculum onset, residents participated in an increasing number of robotic operative cases and were actively engaged in simulation exercises. The establishment of this curriculum has facilitated the integration of resident education into the utilization of robotic technology. This study highlights the value of a formal robotic surgery curriculum for general surgery residency training.
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Affiliation(s)
- Hailee R Grannan
- Department of Surgery, Division of General Surgery, Medical College of Wisconsin, Milwaukee, WI
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Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy. J Robot Surg 2020; 15:619-626. [DOI: 10.1007/s11701-020-01146-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
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Mangano MS, Lamon C, Beniamin F, De Gobbi A, Ciaccia M, Maccatrozzo L. The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes. Urologia 2020; 88:9-13. [PMID: 32807046 DOI: 10.1177/0391560320951085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the impact of the bedside assistant's experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon's experience. MATERIALS AND METHODS All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient's parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. RESULTS A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.
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Affiliation(s)
- Mario Salvatore Mangano
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Claudio Lamon
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Francesco Beniamin
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Alberto De Gobbi
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Matteo Ciaccia
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Luigino Maccatrozzo
- Struttura Complessa di Urologia, Ospedale Ca' Foncello Treviso, ULSS 2 Marca Trevigiana, Treviso, Italy
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Zeuschner P, Meyer I, Siemer S, Stoeckle M, Wagenpfeil G, Wagenpfeil S, Saar M, Janssen M. Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis. Ann Surg Oncol 2020; 28:1254-1261. [PMID: 32710272 PMCID: PMC7801306 DOI: 10.1245/s10434-020-08856-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/15/2020] [Indexed: 01/20/2023]
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has become widely accepted, but its different underlying types of learning curves have not been comparatively analyzed to date. This study aimed to determine and compare the impact that the learning curve of the department, the console surgeon, and the bedside assistant as well as patient-related factors has on the perioperative outcomes of RAPN. Methods The study retrospectively analyzed 500 consecutive transperitoneal RAPNs (2007–2018) performed in a tertiary referral center by 7 surgeons and 37 bedside assistants. Patient characteristics and surgical data were obtained. Experience (EXP) was defined as the current number of RAPNs performed by the department, the surgeon, and the assistant. As the primary outcome, the impact of EXP and patient-related factors on perioperative outcomes were analyzed and compared. As the secondary outcome, a cutoff between “experienced” and “inexperienced” was defined. Correlation and regression analysis, receiver operating characteristic curve analysis, Fisher’s exact test, and the Mann–Whitney U test were performed, with p values lower than 0.05 denoting significance. Results The EXP of the department, the surgeon, and the assistant each has a major influence on perioperative outcome in RAPN irrespective of patient-related factors. Perioperative outcomes improve significantly with EXP greater than 100 for the department, EXP greater than 35 for the surgeon, and EXP greater than 15 for the assistant. Conclusions The perioperative results of RAPN are influenced by three different types of learning curves including those for the surgical department, the console surgeon, and the assistant. The influence of the bedside assistant clearly has been underestimated to date because it has a significant impact on the perioperative outcomes of RAPN. Electronic supplementary material The online version of this article (10.1245/s10434-020-08856-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stoeckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany. .,Department of Urology and Pediatric Urology, University Hospital of Munster, Münster, Germany.
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Zhao B, Lam J, Hollandsworth HM, Lee AM, Lopez NE, Abbadessa B, Eisenstein S, Cosman BC, Ramamoorthy SL, Parry LA. General surgery training in the era of robotic surgery: a qualitative analysis of perceptions from resident and attending surgeons. Surg Endosc 2020; 34:1712-1721. [PMID: 31286248 PMCID: PMC6946889 DOI: 10.1007/s00464-019-06954-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of the surgical robot has increased annually since its introduction, especially in general surgery. Despite the tremendous increase in utilization, there are currently no validated curricula to train residents in robotic surgery, and the effects of robotic surgery on general surgery residency training are not well defined. In this study, we aim to explore the perceptions of resident and attending surgeons toward robotic surgery education in general surgery residency training. METHODS We performed a qualitative thematic analysis of in-person, one-on-one, semi-structured interviews with general surgery residents and attending surgeons at a large academic health system. Convenient and purposeful sampling was performed in order to ensure diverse demographics, experiences, and opinions were represented. Data were analyzed continuously, and interviews were conducted until thematic saturation was reached, which occurred after 20 residents and seven attendings. RESULTS All interviewees agreed that dual consoles are necessary to maximize the teaching potential of the robotic platform, and the importance of simulation and simulators in robotic surgery education is paramount. However, further work to ensure proper access to simulation resources for residents is necessary. While most recognize that bedside-assist skills are essential, most think its educational value plateaus quickly. Lastly, residents believe that earlier exposure to robotic surgery is necessary and that almost every case has a portion that is level-appropriate for residents to perform on the robot. CONCLUSIONS As robotic surgery transitions from novelty to ubiquity, the importance of effective general surgery robotic surgery training during residency is paramount. Through in-depth interviews, this study provides examples of effective educational tools and techniques, highlights the importance of simulation, and explores opinions regarding the role of the resident in robotic surgery education. We hope the insights gained from this study can be used to develop and/or refine robotic surgery curricula.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA.
| | - Jenny Lam
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Hannah M Hollandsworth
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Arielle M Lee
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Nicole E Lopez
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Benjamin Abbadessa
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Samuel Eisenstein
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Bard C Cosman
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Sonia L Ramamoorthy
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Lisa A Parry
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
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Zhao B, Hollandsworth HM, Lee AM, Lam J, Lopez NE, Abbadessa B, Eisenstein S, Cosman BC, Ramamoorthy SL, Parry LA. Making the Jump: A Qualitative Analysis on the Transition From Bedside Assistant to Console Surgeon in Robotic Surgery Training. JOURNAL OF SURGICAL EDUCATION 2020; 77:461-471. [PMID: 31558428 PMCID: PMC7036000 DOI: 10.1016/j.jsurg.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/21/2019] [Accepted: 09/15/2019] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine barriers associated with the transition from bedside assistant to console surgeon for general surgery residents in the era of robotic surgery in general surgery training. DESIGN Qualitative thematic analysis using one-on-one interviews of general surgery residents and attendings conducted between June 2018 and February 2019. SETTING An urban, academic, multihospital general surgery residency program with a robust robotic surgery program. PARTICIPANTS Convenient and purposeful sampling was performed to ensure a variety of resident graduate-years and attending subspecialties were represented. Sample size was determined by data saturation, which occurred after 20 resident and 7 attending interviews. RESULTS Residents identified the low volume of general surgery robotic cases, the infrequency of exposure to robotic surgery, and attending comfort with robotic surgery (and with teaching on the robot) as potential barriers in the transition from bedside assistant to console surgeon. Residents had to find a replacement bedside assistant in order to be the console surgeon, which was challenging. In addition, residents felt that the current culture surrounding robotic surgery is very hierarchal, limiting their exposure. Attendings' trust in the residents' console skills was a major determining factor in allowing residents on the console. CONCLUSIONS Most robotic surgery education curricula are sequential, requiring the resident to progress from bedside assistant to console surgeon. Unfortunately, there are many potential barriers for residents in the transition from bedside assistant to console surgeon. Some barriers apply to general surgery training overall, but are amplified in robotic surgery, while others are unique to robotic surgery education. Recognition of, and rectifying, these barriers may increase resident participation as the console surgeon.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California San Diego, La Jolla, California.
| | | | - Arielle M Lee
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Jenny Lam
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Nicole E Lopez
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Benjamin Abbadessa
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Samuel Eisenstein
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Bard C Cosman
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
| | - Sonia L Ramamoorthy
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Lisa A Parry
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
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Cimen HI, Atik YT, Altinova S, Adsan O, Balbay MD. Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy? Int Braz J Urol 2019; 45:54-60. [PMID: 30521164 PMCID: PMC6442128 DOI: 10.1590/s1677-5538.ibju.2018.0184] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.
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Affiliation(s)
- Haci Ibrahim Cimen
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
| | - Yavuz Tarik Atik
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
| | - Serkan Altinova
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Oztug Adsan
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
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Pathak RA, Edge CC, Thomas GM, Thiel DD, Broderick GA, La Rosa D, Lannen A, Moore MC, Frank RD, Igel TC. Vasectomy Simulation Curriculum and Trainer with Enhanced Face, Content and Construct Validity. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ram A. Pathak
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Carl C. Edge
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Garrett M. Thomas
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - David D. Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | - Delaney La Rosa
- J. Wayne and Delores Barr Weaver Simulation Center, Department of Education, Mayo Clinic, Jacksonville, Florida
| | - Amy Lannen
- J. Wayne and Delores Barr Weaver Simulation Center, Department of Education, Mayo Clinic, Jacksonville, Florida
| | - Monica C. Moore
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Ryan D. Frank
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Todd C. Igel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Abstract
PURPOSE OF REVIEW Robot-assisted radical prostatectomy (RARP) has been embraced by urologists and has become a treatment standard in many countries already. Learning how to perform a RARP is challenging and has not yet been standardized. The current review summarizes the latest concepts regarding the most effective way of training for RARP. RECENT FINDINGS The strategy to learn RARP should comprise didactic activities, skills lab training, participating in surgeries and mentorship. Skills lab and virtual simulators are valuable tools to develop manual abilities and to overcome the initial technical learning curve. Participating in surgeries is crucial for familiarization with the robot installation, steps of the surgical procedure and is essential for troubleshooting. Mentorship improves learning and is the safest way to initiate real practice. Innate and individual background variances were suggested to influence the learning process; however, there is paucity of robust evidence correlating previous surgical experience and, for example videogame playing with faster learning of RARP. Structured curricula were proposed to orient the training for robotic surgery; currently, only one is focused exclusively on urology. SUMMARY Systematic training is the most effective way to learn and surpass the possibly intense learning curve of RARP. Training activities should focus on developing cognitive and manual abilities. The existing curricula for robotic surgery training still require constant refinement; however, they offer good and structured guidance to train for RARP.
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Face and content validity of Xperience™ Team Trainer: bed-side assistant training simulator for robotic surgery. Updates Surg 2017; 70:113-119. [DOI: 10.1007/s13304-017-0509-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 12/16/2017] [Indexed: 01/16/2023]
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Moore MD, Afaneh C, Gray KD, Panjwani S, Fahey TJ, Pomp A, Zarnegar R. The impact of the robotic platform on assistant variability in complex gastrointestinal surgery. J Surg Res 2017; 219:98-102. [DOI: 10.1016/j.jss.2017.05.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 01/18/2023]
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Abstract
The aim of this study was to explore the work experience of perioperative nurses involved in robotic surgery. A qualitative descriptive study was conducted. Participants were 15 nurses who had been on a robotic surgery team at one of five major university hospitals in Seoul, South Korea. Participants were one male and 14 female nurses (mean age, 31.33 [SD, 4.19] years; range, 25-41 years). Their experience as robotic surgery nurses ranged from 8 months to 6 years. Nurses' experiences with robotic surgery were categorized within four main themes: (1) constant checking on patients' safety and the robot's functions; (2) unexpected robotic machine errors or malfunctions; (3) feelings of burden in a robotic surgical team; and (4) need and desire for more information and education. This study showed that there are common concerns about patient safety and the possibility of emergencies related to robot system failure among nurses. Offering more support for nurses involved in robotic surgery should be a priority to empower them to play an extended role in robotic surgery.
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Schommer E, Tonkovich K, Li Z, Thiel DD. Impact of Resident Involvement on Robot-Assisted Radical Prostatectomy Outcomes. J Endourol 2016; 30:1126-1131. [PMID: 27445128 DOI: 10.1089/end.2016.0388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP). METHODS The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases. RESULTS Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012. CONCLUSIONS Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.
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Affiliation(s)
- Eric Schommer
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
| | - Kolbi Tonkovich
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
| | - Zhuo Li
- 2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida
| | - David D Thiel
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
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16
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Potretzke AM, Knight BA, Brockman JA, Vetter J, Figenshau RS, Bhayani SB, Benway BM. The role of the assistant during robot-assisted partial nephrectomy: does experience matter? J Robot Surg 2016; 10:129-34. [PMID: 27039192 DOI: 10.1007/s11701-016-0582-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/19/2016] [Indexed: 01/12/2023]
Abstract
The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center.
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Affiliation(s)
- Aaron M Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA.
| | - Brent A Knight
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - John A Brockman
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Joel Vetter
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Brian M Benway
- Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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17
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Lovegrove CE, Elhage O, Khan MS, Novara G, Mottrie A, Dasgupta P, Ahmed K. Training Modalities in Robot-assisted Urologic Surgery: A Systematic Review. Eur Urol Focus 2016; 3:102-116. [PMID: 28720354 DOI: 10.1016/j.euf.2016.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Novel surgical techniques demand that surgical training adapts to the need for technical and nontechnical skills. OBJECTIVE To identify training methods available for robot-assisted surgical (RAS) training in urology, evaluate their effectiveness in terms of validation, educational impact, acceptability, and cost effectiveness, and assess their effect on learning curves (LCs). EVIDENCE ACQUISITION A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines searched Ovid Medline, Embase, PsycINFO, and the Cochrane Library. Results were screened to include appropriate studies. Quality was evaluated. Each method was evaluated, and conclusions were drawn regarding LCs. EVIDENCE SYNTHESIS Of 359 records, 24 were included (521 participants). Training methods included dry-lab training (n=7), wet-lab training (n=7), mentored training (n=7), and nonstructured pathways (n=5). Dry-lab training demonstrated educational impact by reducing console time and was acceptable in a study; 100% of participants confirmed face validity. Wet-lab training principally uses human cadaveric material; effectiveness is well rated, although dry-lab training and observation were rated as equally useful. Mentored programmes combine lectures, tutorials, observation, simulation, and proctoring. Minifellowships were linked to greater practice of RAS 1 yr later. LCs vary according to experience. One study found that surgeons from robot-related fellowships demonstrated fewer positive surgical margins than surgeons from laparoscopic-related fellowships (24% vs 34.6%; p=0.05) and reduced time (132 vs 152min; p=0.0003). Five studies examined nonstructured training pathways (clinical practice). Experience correlated with fewer complications (p=0.007), improved continence (p=0.049), and reduced time (p=0.002). CONCLUSIONS RAS training methods include dry and wet lab, mentored training, and nonstructured pathways. Limited available evidence suggests that they affect LCs differently and are rarely used alone. The different methods of training appear effective when combined. Their benefits must be explored to facilitate validated acceptable training with educational impact. PATIENT SUMMARY Robot-assisted training encompasses several methods used in combination, but more evidence is required to gain the greatest benefit and formulate future training pathways.
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Affiliation(s)
- Catherine Elizabeth Lovegrove
- MRC Centre for Transplantation, NIHR Biomedical Research Centre, King's Health Partners, King's College London, London, UK
| | - Oussama Elhage
- MRC Centre for Transplantation, NIHR Biomedical Research Centre, King's Health Partners, King's College London, London, UK
| | - M Shamim Khan
- Departments of Urology and Nephrology & Renal Transplantation, Guy's & St Thomas' Hospital, London, UK
| | | | - Alex Mottrie
- O.L.V. Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Prokar Dasgupta
- MRC Centre for Transplantation, NIHR Biomedical Research Centre, King's Health Partners, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, NIHR Biomedical Research Centre, King's Health Partners, King's College London, London, UK.
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18
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Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules. J Robot Surg 2016; 10:49-56. [DOI: 10.1007/s11701-015-0540-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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19
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Mottrie A, Novara G, van der Poel H, Dasgupta P, Montorsi F, Gandaglia G. The European Association of Urology Robotic Training Curriculum: An Update. Eur Urol Focus 2015; 2:105-108. [PMID: 28723444 DOI: 10.1016/j.euf.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/05/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022]
Abstract
The European Association of Urology robotic training curriculum is a validated structured program to provide standardized training and to certify surgeons for specific urologic procedures.
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Affiliation(s)
- Alexandre Mottrie
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
| | - Giacomo Novara
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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20
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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: 2.8] [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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21
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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: 1.8] [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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22
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Liu M, Curet M. A review of training research and virtual reality simulators for the da Vinci surgical system. TEACHING AND LEARNING IN MEDICINE 2015; 27:12-26. [PMID: 25584468 DOI: 10.1080/10401334.2014.979181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. APPROACH This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. FINDINGS An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.
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Affiliation(s)
- May Liu
- a Medical Research Department , Intuitive Surgical, Inc. , Sunnyvale , California , USA
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23
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Abstract
BACKGROUND Hemorrhage is a potentially preventable cause of adverse outcomes in surgical and obstetric patients. New understanding of the pathophysiology of hemorrhagic shock, including development of coagulopathy, has led to evolution of recommendations for treatment. However, no recent study has examined the legal outcomes of these claims. The authors reviewed closed anesthesia malpractice claims related to hemorrhage, seeking common factors to guide future management strategies. METHODS The authors analyzed 3,211 closed surgical or obstetric anesthesia malpractice claims from 1995 to 2011 in the Anesthesia Closed Claims Project. Claims where patient injury was attributed to hemorrhage were compared with all other surgical and obstetric claims. Risk factors for hemorrhage and coagulopathy, clinical factors, management, and communication issues were abstracted from claim narratives to identify recurrent patterns. RESULTS Hemorrhage occurred in 141 (4%) claims. Obstetrics accounted for 30% of hemorrhage claims compared with 13% of nonhemorrhage claims (P < 0.001); thoracic or lumbar spine surgery was similarly overrepresented (24 vs. 6%, P < 0.001). Mortality was higher in hemorrhage than nonhemorrhage claims (77 vs. 27%, P < 0.001), and anesthesia care was more often judged to be less than appropriate (55 vs. 38%, P < 0.001). Median payments were higher in hemorrhage versus nonhemorrhage claims ($607,750 vs. $276,000, P < 0.001). Risk factors for hemorrhage and coagulopathy were common, and initiation of transfusion therapy was commonly delayed. CONCLUSIONS Hemorrhage is a rare, but serious, cause of anesthesia malpractice claims. Understanding which patients are at risk can aid in patient referral decisions, design of institutional systems for responding to hemorrhage, and education of surgeons, obstetricians, and anesthesiologists.
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Yim GW, Kim SW, Nam EJ, Kim S, Kim HJ, Kim YT. Surgical outcomes of robotic radical hysterectomy using three robotic arms versus conventional multiport laparoscopy in patients with cervical cancer. Yonsei Med J 2014; 55:1222-30. [PMID: 25048478 PMCID: PMC4108805 DOI: 10.3349/ymj.2014.55.5.1222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/18/2014] [Accepted: 03/28/2014] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of conventional laparoscopy in patients with early cervical cancer. MATERIALS AND METHODS A retrospective cohort study included 102 patients with stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissection performed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups. RESULTS Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopic approach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5±61.1 minutes vs. 215.6±83.1 minutes, p=0.319), mean number of lymph node yield (23.3±9.3 vs. 21.7±9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopic cohort. CONCLUSION Surgical outcomes of RRH and pelvic lymphadenectomy were comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications.
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Affiliation(s)
- Ga Won Yim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Ruparel RK, Taylor AS, Patel J, Patel VR, Heckman MG, Rawal B, Leveillee RJ, Thiel DD. Assessment of virtual reality robotic simulation performance by urology resident trainees. JOURNAL OF SURGICAL EDUCATION 2014; 71:302-308. [PMID: 24797844 DOI: 10.1016/j.jsurg.2013.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine resident performance on the Mimic dV-Trainer (MdVT; Mimic Technologies, Inc., Seattle, WA) for correlation with resident trainee level (postgraduate year [PGY]), console experience (CE), and simulator exposure in their training program to assess for internal bias with the simulator. DESIGN Residents from programs of the Southeastern Section of the American Urologic Association participated. Each resident was scored on 4 simulator tasks (peg board, camera targeting, energy dissection [ED], and needle targeting) with 3 different outcomes (final score, economy of motion score, and time to complete exercise) measured for each task. These scores were evaluated for association with PGY, CE, and simulator exposure. SETTING Robotic skills training laboratory. PARTICIPANTS A total of 27 residents from 14 programs of the Southeastern Section of the American Urologic Association participated. RESULTS Time to complete the ED exercise was significantly shorter for residents who had logged live robotic console compared with those who had not (p = 0.003). There were no other associations with live robotic console time that approached significance (all p ≥ 0.21). The only measure that was significantly associated with PGY was time to complete ED exercise (p = 0.009). No associations with previous utilization of a robotic simulator in the resident's home training program were statistically significant. CONCLUSIONS The ED exercise on the MdVT is most associated with CE and PGY compared with other exercises. Exposure of trainees to the MdVT in training programs does not appear to alter performance scores compared with trainees who do not have the simulator.
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Affiliation(s)
- Raaj K Ruparel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | - Abby S Taylor
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | - Janil Patel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | - Michael G Heckman
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Jacksonville, Florida
| | - Bhupendra Rawal
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Jacksonville, Florida
| | | | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida.
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