Effectiveness of a dedicated robot-assisted surgery training program.

INTRODUCTION: Robot-assisted surgery (RAS) has been integrated into the surgical armamentarium and generated wide-spread interest among practicing, non-robotic surgeons (NRS). While methods for training novice non-robotic surgeons have emerged, the effectiveness of these training programs has endured minimal scrutiny. This study aims to establish effectiveness of the RAST training program. MATERIALS AND METHODS: A formal RAST program was established at Roswell Park Cancer Institute (RPCI) in 2008. From July 2010 to October 2012, 43 non-robotic surgeons participated in the program. The 1 to 4 week program included the validated fundamentals skills of robotic surgery (FSRS) curriculum, hands-on bedside trouble-shooting training, case observation with an expert robotic surgeon, hands on surgical training (HoST) procedure modules, da Vinci robotic surgical hands-on experience and finally a compulsory animal laboratory utilizing the da Vinci. As part of our training and credentialing quality assurance program, all participants were prospectively evaluated employing a survey. This survey aimed to evaluate the enduring impact of the RAST through time-sensitive interventions that allowed participants to reacclimatize themselves to their prospective practice as independently performing surgeons. RESULTS: The survey responses received from the participating NRS were collected over 27 months, with a response rate of 84%. The average follow up period post-RAST completion was 6 months (2-19). Overall, participants felt that the FSRS curriculum (81%), bedside trouble shooting (7%), and animal laboratory (53%) were beneficial program features that enabled NRS to become adequately acquainted with the basic principles of RAS. Approximately 5 weeks after RAST program completion, 64% of surgeons performed robot-assisted surgery. The two most commonly performed procedures were robot-assisted radical prostatectomy and gastrointestinal surgeries where eight surgeons performed independently while 12 performed procedures under the supervision of an expert robotic surgeon. The overall conversion rate to open was reported to be 1.3%. CONCLUSIONS: A dedicated surgical training program focused on learning key steps of RAS enabled most participants to successfully incorporate and maintain their RAS skills in clinical practice.

Comparative analysis of global practice patterns in urologic robot-assisted surgery.

OBJECTIVES: To determine and compare the status of urologic laparoscopic and robot-assisted surgery (RAS) across the world. METHODS: Two hundred ninety-one surveys were completed by urologists at various national and international conferences in 2008. The 58-item questionnaire assessed the individual and institutional practice patterns of minimally invasive surgery with a focus on RAS. Surveys from Europe and North American continents (ENA) were compared with surveys from the Middle East and Asian continents (MEA). RESULTS: One hundred sixty-six (57%) surveys were completed by urologists from MEA and 125 (43%) from ENA. Eighty percent of respondents performed minimally invasive surgery, with 64% having prior formal training. Respondents in ENA were more likely to have had formal training in RAS and performed more RAS cases (p < 0.01). Sixty percent of those surveyed from ENA had used robotic consoles in training courses compared with only 20% in MEA (p < 0.01). Dedicated RAS support teams were less common in MEA (p < 0.01). Lack of a robotic system was the most common deterrent for RAS in MEA (56%). Respondents in ENA performed more robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy. In the more established robotic environment of ENA, robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy represented the gold standard in 34%, 14%, and 26% of surveys, respectively. Comparatively, MEA respondents were more likely to believe RAS represented the gold standard. CONCLUSIONS: Usage of RAS in urology continues to grow across the globe, though to most it represents a surgical alternative rather than benchmark. Even with reduced exposure, training, and access, more urologists in the MEA considered RAS to be the surgical standard for prostatectomy, cystectomy, and nephrectomy. The evolution of attitudinal change should be the focus of further study.

Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons.

PURPOSE: The surgical robot is becoming an important tool for performance of minimally invasive surgical procedures around the world. We surveyed opinions about and utilization of robot-assisted surgery among urologic surgeons from 44 countries. MATERIAL AND METHODS: A total of 297 surveys were completed from September to November 2008 by participating urologic surgeons polled at various national and international urologic meetings. The survey evaluated surgeon background, personal experience with minimally invasive surgery, institutional status regarding robotic surgery surgeons' attitudes towards robot-assisted surgery, in general, and prostate, bladder and kidney oncologic procedures, specifically. RESULTS: Two hundred ninety-seven participants completed the survey of which 35% were in training for and 54% in practice of urology. Although 57% of these participants were older than 40, 62% had never sat on a robotic surgical console but 61% believed they would perform robot-assisted surgery. Seventy-eight percent of respondents felt it was required or beneficial to have training in robot-assisted surgery. Only 21% of respondents were currently performing robot-assisted radical prostatectomy. Sixty-one percent of respondents felt robot-assisted radical prostatectomy was the current gold standard or as good as laparoscopic prostatectomy. Only 10% had performed robot-assisted radical cystectomy and 70% of these surgeons have transferred skills from robot-assisted radical prostectomy. Ten percent were performing robot-assisted radical nephrectomies and 30% had transferred skills for laparoscopic partial nephrectomy to robot-assisted partial nephrectomy. CONCLUSION: Robot-assisted surgery has begun to integrate into the minimally invasive armamentarium for urologic surgery and is applied for more procedures as experience is gained.

Impact of robotics and laparoscopy on surgical skills: A comparative study.

BACKGROUND: This study objectively surveyed and compared the ability of participants to perform laparoscopic and robotic tasks, and attempted to determine the key advantages of each modality. STUDY DESIGN: A task-based training course was developed that included laparoscopic and robotic task modules. Twenty-two participants (6 faculty members, 6 fellows, and 10 residents) completed a pretask and posttask questionnaire concerning 3 tasks, using both laparoscopy trainer and the daVinci robotic system (Intuitive Surgical, Inc). All tasks were timed and values were recorded. The surveys were completed by each participant to assess both pre- and posttask experiences. RESULTS: In the pretask survey, 55% of subjects reported participating in more than 20 laparoscopic cases, and only 27% had ever worked at a robotic console. The median number of beads threaded in 5 minutes was similar for the 2 methods, but the median time to complete 5 beads was 98 seconds for the laparoscope compared with 160 seconds using the robot (p = 0.001). The median number of loops completed in 5 minutes was greater (p < 0.001) using the robot (7.5 versus 2). Only 9% of subjects completed 9 loops in 5 minutes using the laparoscope; 50% did so using the robot (p < 0.05). The percentage of subjects completing 3 knots in 5 minutes was similar when using the laparoscope (45%) and robot (68%). Familiarity and tactile feedback were the primary advantages with laparoscopy, and EndoWrist (Intuitive Surgical, Inc) and stereoscopic visualization were perceived as advantages of the robot. CONCLUSIONS: As with any new technology, skills must be mastered to use robotic technology for the most benefit. The EndoWrist action and stereoscopic visualization were the most valued advantages of the robot. Most fellows and residents would seek additional training in robotics if given the opportunity.