Robotic-Assisted Surgery Training (RAST) Program: An Educational Research Protocol

2021 ◽  
Author(s):  
Maria Castaldi ◽  
Mathias Palmer ◽  
Jorge Con ◽  
Ziad Abouezzi ◽  
Rifat Latifi ◽  
...  
Keyword(s):  
Educational Research ◽  
Operating Room ◽  
Operating Time ◽  
Technical Skills ◽  
Educational Environment ◽  
Research Protocol ◽  
Robotic Assisted ◽  
Surgery Training ◽  
Robotic Assisted Surgery ◽  
Over Time

Technology has had a dramatic impact on how diseases are diagnosed and treated. Although cut, sew, and tie remain the staples of surgical craft, new technical skills are required. While there is no replacement for live operative experience, training outside the operating room offers structured educational opportunities and stress modulation. A stepwise program for acquiring new technical skills required in robotic surgery involves three modules: ergonomic, psychomotor, and procedural. This is a prospective, educational research protocol aiming at evaluating the responsiveness of general surgery residents in Robotic-Assisted Surgery Training (RAST). Responsiveness is defined as change in performance over time. Performance is measured by the following content-valid metrics for each module. Module 1 proficiency in ergonomics includes: cart deploy, boom control, cart driving, camera port docking, targeting anatomy, flex joint, clearance joint and port nozzle adjusting, and routine and emergent undocking. Module 2 proficiency in psychomotor skills includes tissue handling, accuracy error, knot quality, and operating time. Module 3 proficiency in procedural skills prevents deviations from standardized sequential procedural steps in order to test length of specimen resection, angle for transection, vessel stump length post ligation, distance of anastomosis from critical landmarks, and proximal and distal resection margins. Resident responsiveness over time will be assessed comparing the results of baseline testing with final testing. Educational interventions will include viewing one instructional video prior to module commencement, response to module-specific multiple-choice questions, and individual weekly training sessions with a robotic instructor in the operating room. Residents will progress through modules upon successful final testing and will evaluate the educational environment with the Dundee Ready Educational Environment Measure (DREEM) inventory. The RAST program protocol outlined herein is an educational challenge with the primary endpoint to provide evidence that formal instruction has an impact on proficiency and safety in executing robotic skills.

Robotic Thoracic Surgery Training for Residency Programs

2018 ◽  
Vol 13 (6) ◽  
pp. 417-422 ◽  
Author(s):  
Wissam N. Raad ◽  
Adil Ayub ◽  
Chyun-Yin Huang ◽  
Landon Guntman ◽  
Sadiq S. Rehmani ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Residency Program ◽  
Program Directors ◽  
Robotic Assisted ◽  
Surgery Training ◽  
Robotic Assisted Surgery ◽  
Robotic Surgery Training ◽  
Surgery Residency Program ◽  
Residency Program Directors

Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.

An analysis of operating time over the years for robotic-assisted surgery in gynecology and gynecologic oncology

2020 ◽  
Author(s):  
Anupama Rajanbabu ◽  
Viral Patel ◽  
Anandita Anandita ◽  
Kaustubh Burde ◽  
Akhila Appukuttan
Keyword(s):  
Gynecologic Oncology ◽  
Operating Time ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery

scholarly journals How to Bring Surgery to the Next Level: Interpretable Skills Assessment in Robotic-Assisted Surgery

2020 ◽  
Vol 36 (6) ◽  
pp. 463-470
Author(s):  
Kristen C. Brown ◽  
Kiran D. Bhattacharyya ◽  
Sue Kulason ◽  
Aneeq Zia ◽  
Anthony Jarc
Keyword(s):  
Logistic Regression ◽  
Technical Skills ◽  
Technical Skill ◽  
Small Subset ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Surgical Trainees ◽  
Objective Metrics ◽  
Data Driven Approach ◽  
Similar Accuracy

<b><i>Introduction:</i></b> A surgeon’s technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique opportunity to develop objective metrics using key elements of intraoperative surgeon behavior which can be captured unobtrusively, such as instrument positions and button presses. Recent studies have shown that objective metrics based on these data (referred to as objective performance indicators [OPIs]) correlate to select clinical outcomes during robotic-assisted radical prostatectomy. However, the current OPIs remain difficult to interpret directly and, therefore, to use within structured feedback to improve surgical efficiencies. <b><i>Methods:</i></b> We analyzed kinematic and event data from da Vinci surgical systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to calculate values that can summarize the use of robotic instruments, referred to as OPIs. These indicators were mapped to broader technical skill categories of established training protocols. A data-driven approach was then applied to further sub-select OPIs that distinguish skill for each technical skill category within each training task. This subset of OPIs was used to build a set of logistic regression classifiers that predict the probability of expertise in that skill to identify targeted improvement and practice. The final, proposed feedback using OPIs was based on the coefficients of the logistic regression model to highlight specific actions that can be taken to improve. <b><i>Results:</i></b> We determine that for the majority of skills, only a small subset of OPIs (2–10) are required to achieve the highest model accuracies (80–95%) for estimating technical skills within clinical-like tasks on a porcine model. The majority of the skill models have similar accuracy as models predicting overall expertise for a task (80–98%). Skill models can divide a prediction into interpretable categories for simpler, targeted feedback. <b><i>Conclusion:</i></b> We define and validate a methodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.

scholarly journals RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings

2021 ◽  
Author(s):  
Julia Schreyer ◽  
Amelie Koch ◽  
Annika Herlemann ◽  
Armin Becker ◽  
Boris Schlenker ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Qualitative Interviews ◽  
Surgical Care ◽  
Technical Skills ◽  
Rater Agreement ◽  
Validity And Reliability ◽  
Delphi Consensus ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Strong Agreement

Abstract Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.

Sign in / Sign up

Export Citation Format

Share Document