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Chan YY, Zhong J, Jacobs MA, Peters CA. Emergent robot-to-open conversion - Multidisciplinary simulation training in crisis management. J Pediatr Urol 2024; 20:751-758. [PMID: 38914507 DOI: 10.1016/j.jpurol.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
Anticipating and addressing unexpected intraoperative events and anatomies are some of the most challenging aspects of pediatric urologic practice; uncontrolled hemorrhage is one of the most anxiety provoking and precarious. The increasing application of the robotic platform in pediatric urology adds another layer of complexity as surgeons are not immediately at the patient's bedside. Should hemorrhage occur in robotic cases, clear communication and seamless coordination between members of the operating room team are paramount to optimize patient safety and minimize errors. This is especially important in pediatric cases for which the margin of error is narrow. Non-technical skills, including leadership, decision-making, situational awareness, stress management, and team-communication, become increasingly critical. While many programs have focused on robotic training, few prepare the operating room team and surgical trainees to manage these unforeseen, emergent intraoperative scenarios. This review discusses the role of a multidisciplinary, in situ robot-to-open conversion simulation program in addressing this educational gap, ways to approach establishing these programs, and potential barriers.
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Affiliation(s)
- Yvonne Y Chan
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA; Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - Micah A Jacobs
- Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - Craig A Peters
- Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
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Mahendran V, Turpin L, Boal M, Francis NK. Assessment and application of non-technical skills in robotic-assisted surgery: a systematic review. Surg Endosc 2024; 38:1758-1774. [PMID: 38467862 PMCID: PMC10978706 DOI: 10.1007/s00464-024-10713-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery. METHODS A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick's validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon's situational awareness. CONCLUSION This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery.
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Affiliation(s)
- Vimaladhithan Mahendran
- MSc Patient Safety and Human Clinical Factors, University of Edinburgh, Edinburgh, UK
- Department of General Surgery, Yeovil District Hospital, Yeovil, UK
| | - Laura Turpin
- Division of Medicine, BSc Applied Medical Sciences, University College London, London, UK
| | - Matthew Boal
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park Hospital, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, University College London, London, UK
| | - Nader K Francis
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK.
- The Griffin Institute, Northwick Park Hospital, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Knudsen JE, Ma R, Hung AJ. Simulation training in urology. Curr Opin Urol 2024; 34:37-42. [PMID: 37909886 PMCID: PMC10842538 DOI: 10.1097/mou.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW This review outlines recent innovations in simulation technology as it applies to urology. It is essential for the next generation of urologists to attain a solid foundation of technical and nontechnical skills, and simulation technology provides a variety of safe, controlled environments to acquire this baseline knowledge. RECENT FINDINGS With a focus on urology, this review first outlines the evidence to support surgical simulation, then discusses the strides being made in the development of 3D-printed models for surgical skill training and preoperative planning, virtual reality models for different urologic procedures, surgical skill assessment for simulation, and integration of simulation into urology residency curricula. SUMMARY Simulation continues to be an integral part of the journey towards the mastery of skills necessary for becoming an expert urologist. Clinicians and researchers should consider how to further incorporate simulation technology into residency training and help future generations of urologists throughout their career.
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Affiliation(s)
| | - Runzhuo Ma
- Department of Urology, Cedars-Sinai Medical Center; Los Angeles, California, USA
| | - Andrew J Hung
- Department of Urology, Cedars-Sinai Medical Center; Los Angeles, California, USA
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Labadie KP, Melstrom LG, Lewis AG. Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience. J Surg Oncol 2023; 128:1347-1352. [PMID: 37781938 DOI: 10.1002/jso.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
Laparoscopic and robotic-assisted approaches to hepatopancreatobiliary (HPB) operations have expanded worldwide. As surgeons and medical centers contemplate initiating and expanding minimally invasive surgical (MIS) programs for complex HPB surgical operations, there are many factors to consider. This review highlights the key components of developing an MIS HPB program and shares our recent institutional experience with the adoption and expansion of an MIS approach to pancreaticoduodenectomy.
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Affiliation(s)
- Kevin P Labadie
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
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Burke JR, Fleming CA, King M, El-Sayed C, Bolton WS, Munsch C, Harji D, Bach SP, Collins JW. Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum. J Robot Surg 2023; 17:1443-1455. [PMID: 36757562 PMCID: PMC9909133 DOI: 10.1007/s11701-022-01518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/31/2022] [Indexed: 02/10/2023]
Abstract
Robot-assisted surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational stakeholders guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee. The study was conducted in four Phases: P1: a steering group was formed to review current literature and summarise the evidence, P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to the three round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. There was 100% response from all three rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of > 0.8. There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment. Using the Delphi methodology, we achieved multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC. This guidance will benefit from further validation following implementation.
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Affiliation(s)
- Joshua Richard Burke
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Christina A. Fleming
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- The Royal College of Surgeons, Dublin, Ireland
| | - Martin King
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Craigavon Area Hospital, Craigavon, Northern Ireland
| | - Charlotte El-Sayed
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | | | - Chris Munsch
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
| | - Deena Harji
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon P. Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Justin W. Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), UK, University College London, London, UK
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Chan Y, Ellison J. What the editors are reading: Quality improvement and patient safety. J Pediatr Urol 2022; 18:700-703. [PMID: 36244900 DOI: 10.1016/j.jpurol.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Jonathan Ellison
- Medical College of Wisconsin, Department of Urology, Milwaukee, USA.
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Protecting procedural care-cybersecurity considerations for robotic surgery. NPJ Digit Med 2022; 5:148. [PMID: 36127420 PMCID: PMC9489690 DOI: 10.1038/s41746-022-00693-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
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