Educational note: teaching and training in robotic surgery. An opinion of the Minimally Invasive and Robotic Surgery Committee of the Brazilian College of Surgeons

ABSTRACT With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.

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Visual Measurement of Suture Strain for Robotic Surgery

Computational and Mathematical Methods in Medicine ◽

10.1155/2011/879086 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 16

Author(s):

John Martell ◽

Thomas Elmer ◽

Nachappa Gopalsami ◽

Young Soo Park

Keyword(s):

Robotic Surgery ◽

Minimally Invasive ◽

Surgical Procedures ◽

Video Processing ◽

Postoperative Recovery ◽

Hospital Length ◽

Tactile Feedback ◽

Hospital Length Of Stay ◽

Visual Interpretation ◽

Suture Tension

Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.

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Role of Simulation-Based Training in Minimally Invasive and Robotic Colorectal Surgery

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1718687 ◽

2021 ◽

Vol 34 (03) ◽

pp. 136-143

Author(s):

Sergio Eduardo Alonso Araujo ◽

Rodrigo Oliva Perez ◽

Sidney Klajner

Keyword(s):

Colorectal Surgery ◽

Minimally Invasive ◽

Surgical Simulation ◽

Scientific Evidence ◽

Training Methods ◽

Psychomotor Skills ◽

Advantages And Disadvantages ◽

Transfer Of Skills ◽

Robotic Colorectal Surgery ◽

Minimally Invasive Colorectal Surgery

AbstractProperly performing minimally invasive colorectal procedures requires specific skills. With a focus on patient safety, the training of surgeons on patients is only accepted under exceptionally controlled, expensive, and challenging conditions. Moreover, many new techniques in colorectal surgery have been developed. Therefore, undertaking minimally invasive colorectal surgery in modern times requires specific psychomotor skills that trainee surgeons must gather in less time. In addition, there are not enough proctors with sufficient expertise for such an expressive number of new different techniques likes transanal and robotic procedures.Studies that have demonstrated an improvement in minimally invasive surgery skills to the actual operating room in general surgery and a stepwise approach to surgical simulation with a combination of various training methods appears to be useful in colorectal surgery training programs. However, the scientific evidence on the transfer of skills specifically for colorectal surgery is extremely scarce and very variable. Thus, the evaluation of the results remains quite difficult. In this review, we present the best available evidence on the types of training based on simulation, their characteristics, advantages and disadvantages, and finally the results available on their adoption. Nevertheless, scientific evidence about the benefit of simulation training in minimally invasive colorectal surgery is limited and there is a need to build more robust evidence.

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Minimally invasive robotic surgery, a perspective from the technological surveillance

2013 Pan American Health Care Exchanges (PAHCE) ◽

10.1109/pahce.2013.6568239 ◽

2013 ◽

Cited By ~ 1

Author(s):

M.F. Ariza ◽

N. Quiroga

Keyword(s):

Robotic Surgery ◽

Minimally Invasive ◽

Minimally Invasive Robotic Surgery

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The “Spacemaker”, a New Device for Minimally Invasive Cardiothoracic Surgery: An Evaluation and Feasibility Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000183 ◽

2015 ◽

Vol 10 (4) ◽

pp. 241-247

Author(s):

Pieter W.J. Lozekoot ◽

Sandro Gelsomino ◽

Paul B. Kwant ◽

Orlando Parise ◽

Francesco Matteucci ◽

...

Keyword(s):

Minimally Invasive ◽

Surgical Procedures ◽

Lung Tissue ◽

Lung Ventilation ◽

Cardiothoracic Surgery ◽

Respiratory Compromise ◽

One Lung Ventilation ◽

New Device ◽

Lead Placement ◽

The Right

Objective Our aim was to evaluate a new inflatable lung retractor, the “Spacemaker”, and its efficacy in facilitating minimally invasive cardiothoracic surgery without the need of one lung ventilation or carbon dioxide overpressure insufflation. Methods The device was tested in 12 anesthetized pigs (90–100 kg) placed on standard endotracheal ventilation. The device was introduced into the right or left side of the chest, depending on the intended procedure to be performed, via a 3-cm incision in the fifth intercostal space. A total of seven animals were used to evaluate hemodynamic and respiratory response to the device, whereas another five animals were used to assess the feasibility of a variety of minimally invasive cardiothoracic surgical procedures. Results Introduction was easy and unhindered. The device was inflated up to 0.6 bar, thereby pushing the lung tissue gently away cranially, posteriorly, and caudally without interfering with pulmonary function or resulting in respiratory compromise. In addition, hemodynamics remained stable throughout the experiments. Different closed-chest surgical procedures such as left atrial appendage exclusion, pulmonary vein exposure, pacemaker lead placement, and endoscopic stabilization for coronary surgery, were successfully performed. Removal was quick and complete in all cases, and lung tissue showed no remnant atelectasis. Conclusions The “Spacemaker” may represent a reliable alternative to current conventional techniques to facilitate minimally invasive cardiothoracic surgery. Further research is warranted to confirm the effectiveness and the safety of this device and to optimize the model before its use in humans and its introduction into clinical practice.

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Design of a novel surgical instrument for minimally invasive robotic surgery

2014 IEEE International Conference on Robotics and Biomimetics (ROBIO 2014) ◽

10.1109/robio.2014.7090334 ◽

2014 ◽

Cited By ~ 1

Author(s):

Bo Pan ◽

GuoJun Niu ◽

YiLi Fu ◽

DianGuo Xu ◽

Yongsheng Wang

Keyword(s):

Robotic Surgery ◽

Minimally Invasive ◽

Surgical Instrument ◽

Minimally Invasive Robotic Surgery

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Trends in the Implementation of Advanced Minimally Invasive Gynecologic Surgical Procedures in The Netherlands

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2015.01.026 ◽

2015 ◽

Vol 22 (4) ◽

pp. 642-647 ◽

Cited By ~ 16

Author(s):

Sara R.C. Driessen ◽

Niki L.M. Baden ◽

Erik W. van Zwet ◽

Andries R.H. Twijnstra ◽

Frank Willem Jansen

Keyword(s):

The Netherlands ◽

Minimally Invasive ◽

Surgical Procedures ◽

Gynecologic Surgical Procedures

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Simulation of complex strabismus surgical procedures on goat eyes

European Journal of Ophthalmology ◽

10.1177/11206721211045190 ◽

2021 ◽

pp. 112067212110451

Author(s):

Amar Pujari ◽

Vaishali Rakheja ◽

Sujeeth Modaboyina ◽

Deep Das ◽

Manasi Tripathi ◽

...

Keyword(s):

Surgical Procedures ◽

Surgical Simulation ◽

Muscle Length ◽

Lateral Rectus ◽

Muscle Quality ◽

Oblique Muscle ◽

Inferior Rectus ◽

Superior Rectus ◽

Ocular Muscle ◽

Superior Oblique

Purpose: To describe the possibility of complex strabismus surgical simulation on goat eyes. Methods: The goat eyes were procured from local slaughterhouse with retained extra ocular muscle tissues. The obtained eyes were inspected for globe integrity, muscle quality, muscle length, and the surrounding teno-conjunctival layers. The included eyes were then segregated for surgical simulation based on their insertion and orientation (as oblique or recti), and they were mounted on a mannequin head, with a fixation suture at free end to simulate the resting tension. Additionally, as per necessary, extra muscles were also transplanted along desired sites to simulate human extra ocular muscle anatomy. Results: The inferior oblique, superior oblique, and all other four recti were successfully simulated in varying proportions in more than 50 eyes. Primarily, by simulating the lateral rectus, inferior rectus, and the inferior oblique muscle, staged weakening procedures of inferior oblique were successfully practiced (Fink’s recession, Park’s recession, Elliot and Nankin procedure, total anterior positioning, and antero-nasal trans-position or Stager’s procedure). Similarly, by simulating superior rectus, inferior rectus, lateral rectus, and the medial rectus muscles, half width transposition, full width transposition, and other complex procedures were practiced (Knapp’s procedure, augmented Knapp’s, Nishida’s procedure, Faden operation, and Y splitting procedure). Furthermore, by simulating superior oblique and the superior rectus muscles, superior oblique tuck, posterior tenectomy, loop tenotomy, and Harada Ito procedures were successfully practiced. Conclusions: On goat eyes, the complex strabismus surgical procedures can be successfully simulated and practiced after re-organizing the existing muscles in different patterns.

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‘She will wear the britsch’: Masculinity and the iconography of Prince Albert

Critical Studies in Men???s Fashion ◽

10.1386/csmf_00025_1 ◽

2020 ◽

Vol 7 (1-2) ◽

pp. 199-222

Author(s):

Hannah Bradshaw

Keyword(s):

Nineteenth Century ◽

Performance Studies ◽

Art History ◽

Male Body ◽

Masculine Ideology ◽

The Creation ◽

Female Rule ◽

And Performance

This article examines the early representations of Prince Albert that either satirize or attempt to reconcile the hierarchical ambiguities and issue of threatened masculinity that resulted from unconventional male consortship and female rule. It concludes that the latter was achieved through the development of a suitable and legible iconography for a nineteenth-century male consort in adherence with British iconographic tradition and values. Drawing from methods in nineteenth-century art history as well as gender and performance studies and anthropology, it argues that images of the male body play a fundamental role in the construction and perpetuation of masculine ideology and subjectivity through the creation of the semblance of an innate and axiomatic masculine archetype. In doing so, this article problematizes and historicizes masculinity by illuminating the plurality of expressions of masculinity and rejecting the essentialist narrative of masculinity as something measurable or quantifiable, as well as ahistorical, atemporal, apolitical and heteronormative.

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Current status of residency training in laparoscopic surgery in Brazil: a critical review

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000100020 ◽

2015 ◽

Vol 28 (1) ◽

pp. 81-85 ◽

Cited By ~ 12

Author(s):

Miguel Prestes NÁCUL ◽

Leandro Totti CAVAZZOLA ◽

Marco Cezário de MELO

Keyword(s):

Laparoscopic Surgery ◽

Endoscopic Surgery ◽

Surgical Simulation ◽

Internship And Residency ◽

Current Status ◽

Professional Activity ◽

Medical Residency ◽

Psychomotor Skills ◽

Residency Programs ◽

Education Medical

INTRODUCTION: The surgeon's formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination. OBJECTIVE: To review the surgical teaching ways used in services that published their results. METHODS: Survey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency. RESULTS: The training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient. Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. CONCLUSION: The establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity.

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