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Stockheim J, Andriof S, Andric M, Al-Madhi S, Acciuffi S, Franz M, Lorenz E, Peglow S, Benedix F, Perrakis A, Croner RS. The training pathway for residents: 'Robotic Curriculum for young Surgeons' (RoCS) does not impair patient outcome during implementation into clinical routine. J Robot Surg 2024; 18:307. [PMID: 39105995 PMCID: PMC11303422 DOI: 10.1007/s11701-024-02056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
The "Robotic Curriculum for young Surgeons" (RoCS) was launched 03/2020 to address the increasing importance of robotics in surgical training. It aims to provide residents with foundational robotic skills by involving them early in their training. This study evaluated the impact of RoCS' integration into clinical routine on patient outcomes. Two cohorts were compared regarding the implementation of RoCS: Cohort 1 (before RoCS) included all robot-assisted procedures between 2017 and 03/2020 (n = 174 adults) retrospectively; Cohort 2 (after RoCS) included all adults (n = 177) who underwent robotic procedures between 03/2020 and 2021 prospectively. Statistical analysis covered demographics, perioperative parameters, and follow-up data, including mortality and morbidity. Subgroup analysis for both cohorts was organ-related (upper gastrointestinal tract (UGI), colorectal (CR), hepatopancreaticobiliary system (HPB)). Sixteen procedures were excluded due to heterogeneity. In-hospital, 30-, 90-day morbidity and mortality showed no significant differences between both cohorts, including organ-related subgroups. For UGI, no significant intraoperative parameter changes were observed. Surgery duration decreased significantly in CR and HPB procedures (p = 0.018 and p < 0.001). Estimated blood loss significantly decreased for CR operations (p = 0.001). The conversion rate decreased for HPB operations (p = 0.005). Length of hospitalization decreased for CR (p = 0.015) and HPB (p = 0.006) procedures. Oncologic quality, measured by histopathologic R0-resections, showed no significant changes. RoCS can be safely integrated into clinical practice without compromising patient safety or oncologic quality. It serves as an effective training pathway to guide robotic novices through their first steps in robotic surgery, offering promising potential for skill acquisition and career advancement.
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Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany.
| | - S Andriof
- Medical Faculty, University Magdeburg, Magdeburg, Germany
| | - M Andric
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Al-Madhi
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Acciuffi
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - M Franz
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - E Lorenz
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - S Peglow
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - F Benedix
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - A Perrakis
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - R S Croner
- Department of General, Visceral, Vascular, and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Tou S, Au S, Clancy C, Clarke S, Collins D, Dixon F, Dreher E, Fleming C, Gallagher AG, Gomez-Ruiz M, Kleijnen J, Maeda Y, Rollins K, Matzel KE. European Society of Coloproctology guideline on training in robotic colorectal surgery (2024). Colorectal Dis 2024; 26:776-801. [PMID: 38429251 DOI: 10.1111/codi.16904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Samson Tou
- Department of Colorectal Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Derby, UK
| | | | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Steven Clarke
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Danielle Collins
- Department of Colorectal Surgery, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Frances Dixon
- Department of Colorectal Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Elizabeth Dreher
- Department of Urology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Christina Fleming
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | | | - Marcos Gomez-Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Yasuko Maeda
- Department of Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katie Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Klaus E Matzel
- Section of Coloproctology, Department of Surgery, University of Erlangen-Nürnberg, FAU, Erlangen, Germany
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Larkins K, Mohamed JE, Mohan H, Heriot A, Warrier S. How I Do It: Structured Narration for Cognitive Simulation-based Training in Robotic Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:624-628. [PMID: 36890046 DOI: 10.1016/j.jsurg.2023.01.010] [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: 10/13/2022] [Revised: 12/05/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Video in robotic surgical education is an important and effective training tool. The educational benefit of video training tools can be enhanced by incorporating cognitive simulation using mental imagery. Narration of robotic surgical training video is an under-explored aspect of video design. Narration can be structured to stimulate visualization and procedural mental mapping. To achieve this, narration should be constructed to follow operative phases and steps and include the procedural, technical and cognitive components. This approach provides a foundation for building an understanding of the key concepts required to safely complete a procedure.
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Affiliation(s)
- Kirsten Larkins
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Jade El Mohamed
- International Medical Robotics Academy, North Melbourne, Victoria, Australia
| | - Helen Mohan
- Austin Health, Heidelberg, Victoria, Australia
| | - Alexander Heriot
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; International Medical Robotics Academy, North Melbourne, Victoria, Australia
| | - Satish Warrier
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; International Medical Robotics Academy, North Melbourne, Victoria, Australia; Department of Surgery, Monash University, Victoria, Australia
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Stockheim J, Perrakis A, Sabel BA, Waschipky R, Croner RS. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2022; 17:495-507. [PMID: 35810233 PMCID: PMC10076401 DOI: 10.1007/s11701-022-01444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
Robotic-assisted procedures gain increasing acceptance for daily surgical routine. However, structured training programs are designed for surgeons with high expertise. Hence, a comprehensive training curriculum was established to ensure a basic competence in robotic abdominal surgery for young surgeons during their residency. The aim of the current work is to propose a feasible and effective training concept. The development process of this training curriculum is based on a comprehensive literature review which led to the concept of "robotic curriculum for young surgeons" (RoCS). It was implemented in the daily routine of a German university hospital starting in 2020. The robotic assessment questionnaire (RAQ) was used for electronic data collection. After the initial phase adjustments, it led to an improvement of the initial version of the curriculum. RoCS is a multimodal training program containing basic training through assistance at the operation table during robotic-assisted operations and basic console training. Key elements are the robotic team time-out (rTTO), perioperative process standardization including feasible personnel scheduling and useful procedure clustering into organ systems, procedural steps and procedural step complexity. Evaluation of standardized communication, performance assessment, patient factors and individual overall workload using NASA Task Load Index is realizable. Flexibility and adaptability to internal organization processes of surgical departments are the main advantages of the concept. RoCS is a strong training tool to meet the specific needs of young surgeons and evaluate their learning success of robotic procedural training. Furthermore, comparison within the different robotic systems should be considered. Further studies are needed to validate a multicenter concept design.
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Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Waschipky
- Department of Information Technology (IT) and Medical Engineering, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Pisani Ceretti A, Opocher E, Bianchi PP. Update on Robotic Rectal Prolapse Treatment. J Pers Med 2021; 11:706. [PMID: 34442349 PMCID: PMC8399170 DOI: 10.3390/jpm11080706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates.
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Affiliation(s)
- Giampaolo Formisano
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Adelona Salaj
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Simona Giuratrabocchetta
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Andrea Pisani Ceretti
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Enrico Opocher
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
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Barros FDE, Felicio VB, Tabet ACL, Cerbone ACC. Training in robotic surgery: initial experience using the Brazilian College of Surgeons model. Rev Col Bras Cir 2021; 48:e20202969. [PMID: 34133655 PMCID: PMC10683448 DOI: 10.1590/0100-6991e-20202969] [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: 02/01/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to present the initial experience of the first tier of surgeons trained in the new model of robotic surgery training proposed by the CBC. METHODS we retrospectively collected data and information on training with the Da Vinci SI robotic system. The variables analyzed were, in the pre-clinical phase, time of completion of each step by surgeon and number of hours in the simulator, and in the clinical phase, operations carried out by the training group, number of surgeons who performed nine procedures in ninety days ("9 in 90"), time of docking, time of console, and results surgical. RESULTS we interviewed 39 surgeons before training started; 20 (51.3%) reached the clinical phase. The average age of surgeons was 47.9 years (38-62). The average time between the first interview and the delivery of the online certificate was 64 days (15-133). The surgeons have made an average of 51h and 36 minutes of robot simulation (40-83 hours). The total number of cases in which the training surgeons participated as first assistant was 418, with an average of 20.9 per surgeon. The time of pre-clinical training had an average of 116 days (48-205). CONCLUSION the new model proposed had good acceptance by all surgeons trained and proved safe in the initial sample.
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Affiliation(s)
- Fernando DE Barros
- - Universidade Federal Fluminense, Departamento de Cirurgia Geral e Especializada - Niterói - RJ - Brasil
- - Hospital São Lucas, Departamento de Cirurgia Geral - Rio de Janeiro - RJ - Brasil
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BIANCHI PP, GIULIANI G, SALAJ A, FERRARO L, OPOCHER E, TOTI F, FORMISANO G. Bottom-up suprapubic approach for robotic right colectomy: technical aspects and preliminary outcomes. Minerva Surg 2021; 76:129-137. [DOI: 10.23736/s2724-5691.20.08664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Feasibility of robotic right colectomy with complete mesocolic excision and intracorporeal anastomosis: short-term outcomes of 161 consecutive patients. Updates Surg 2021; 73:1065-1072. [PMID: 33666853 DOI: 10.1007/s13304-021-01001-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/09/2021] [Indexed: 01/19/2023]
Abstract
Technical and oncological aspects are still debated when dealing with minimally-invasive right colectomy. Main controversial issues still remain about whether the anastomosis should be performed intra- or extracorporeally and if a complete mesocolic excision (CME) should be carried out. We report the feasibility of robotic right colectomy with CME and intracorporeal anastomosis (IA) for right sided colon cancer. Data from patients who underwent robotic right colectomy with IA and CME from January 2015 to April 2020 were prospectively collected and retrospectively analyzed. Intraoperative outcomes and complications (minor I-II and major III-IV according to Clavien-Dindo classification), conversion rate, 30-day postoperative outcomes and pathological outcomes were the variables assessed. A total of 161 patients undergoing robotic right colectomy for cancer met the inclusion criteria. Mean operative time was 185 min, no intraoperative complications were observed, and the conversion rate was 3.7% (6 patients requiring elective conversions). Overall, mean postoperative stay was 4.9 days and the overall 30-day complication rate was 16.1%. 20 patients (12.4%) had minor complications, while major postoperative complications occurred in six patients (3.7%). Anastomotic leak was recorded in one patient (0.6%) and the 30-day re-admission rate was 0.6%. Mean number of harvested lymph nodes was 21.9. Patients requiring conversion experienced two minor complications, with a mean length of stay of 7 days. Robotic right colectomy with CME and IA is feasible and it is associated with good intraoperative and short-term postoperative clinical outcomes.
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Full robotic multivisceral resections: the Modena experience and literature review. Updates Surg 2021; 73:1177-1187. [PMID: 33570711 DOI: 10.1007/s13304-020-00939-8] [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: 06/16/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
The robotic platform is becoming a multidisciplinary tool, versatile, and suitable for multiple procedures. Combined multivisceral resections may represent an alternative to sequential procedures with a potential favorable impact on postoperative morbidity, and on the timing of administration of adjuvant chemotherapy. We herein present our initial experience with full robotic multivisceral resections, and a review of the literature available. Between January 2018 and April 2020, 11 patients underwent multivisceral full robotic abdominal surgery: 4 patients presented with two synchronous tumors, 4 with primary cancer associated with a benign condition and 3 cases involved deep infiltrating endometriosis. Surgical teams enrolled were: General Surgery, Urology and Gynecology. A systematic bibliographic research up to April 2020 was conducted in PubMed. 4 colorectal resections combined with partial or radical nephrectomy were performed, as well as 2 right colectomies in combination with right adrenalectomy and gastric banding removal, 2 radical prostatectomies with Nissen Fundoplication and abdominal wall hernia repair, and 3 resections of deep pelvic endometriosis with colorectal involvement. Mean total operative time was 367 min. No intraoperative complication or conversion to open was registered. Overall postoperative complication rate was 18.2%. 26 papers were included in the review (10 case series and 16 case reports) with a total of 156 combined multivisceral robotic procedures recorded. Robotic combined multivisceral resections proved to be safe and feasible when performed in high volume centers by expert surgeons. The heterogeneity of reports does not allow for a standardization of the procedure. Further studies and accumulation of experience are needed.
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Bianchi PP. Colon surgery: where are we now. MINERVA CHIR 2019; 74:146-147. [PMID: 30834733 DOI: 10.23736/s0026-4733.18.07969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo P Bianchi
- Department of General and Minimally-Invasive Surgery, Misericordia Hospital, Grosseto, Italy -
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