Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> A concern with the initiation of totally endoscopic robotic mitral valve repair (TERMR) programs has been the risk for the learning curve. To minimize this risk, we initiated a TERMR program with a defined team and structured learning approach before clinical implementation. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A dedicated team (two surgeons, one cardiac anesthesiologist, one perfusionist, and two nurses) was trained with clinical scenarios, simulations, wet laboratories, and “expert” observation for 3 months. This team then performed a series of TERMRs of varying complexity. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Thirty-two isolated TERMRs were performed during the first programmatic year. All operations included mitral valve repair, left atrial appendage exclusion, and annuloplasty device implantation. Additional procedures included leaflet resection, neochordae insertion, atrial ablation, and papillary muscle shortening. Longer clamp times were associated with number of neochordae ( P &lt; 0.01), papillary muscle procedures ( P &lt; 0.01), and leaflet resection ( P = 0.06). Sequential case number had no impact on cross-clamp time ( P = 0.3). Analysis of nonclamp time demonstrated a 71.3% learning percentage ( P &lt; 0.01; ie, 28.7% reduction in nonclamp time with each doubling of case number). There were no hospital deaths or incidences of stroke, myocardial infarction, unplanned reoperation, respiratory failure, or renal failure. Median length of stay was 4 days. All patients were discharged home. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Totally endoscopic robotic mitral valve repair can be safely performed after a pretraining regimen with emphasis on experts’ current practice and team training. After a pretraining regimen, cross-clamp times were not subject to learning curve phenomena but were dependent on procedural complexity. Nonclamp times were associated with a short learning curve. </jats:p></jats:sec>

Nursing performance in robotic surgeries: integrative review

“…According to articles A5, A10, A11 and A15, in the intraoperative period, the nurse is responsible for guiding the robotic device for the cart of the patient, performed under the guidance of the surgeon (13,20,(22)(23) . The setting and preparation of the robot for surgery includes the connection of all necessary pieces, such as sterile wrappings and necessary connectors, as well as the calibration process (23) .…”

“…Regarding the preoperative period, seven articles (A1, A2, A3, A4, A5, A7, A9) mentioned the importance of an adequate training both for the nurse and for the entire surgical staff (5,(16)(17)(18)(19)(20)(21) . A training program for nurses allow that the professionals acquire competence and safety on the practice of care, reducing the risks for patients and contributing for positive results in nursing care (21) .…”

“…It is necessary to stress the importance in standardizing the surgical team to improve the care of patients who undergo robotic surgery (17)(18)20) , providing a quality environment that ensures the safety of surgical patients (5,21) .…”

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches

“…For MIMVR programmatic success, it is imperative to develop a stable team and a graduated learning pathway. 28 Team failure is multifactorial and can result from poor patient selection, inadequate mitral procedural volume, too rapid a progression toward robotics, inconsistent tableside surgical assistance, limited experience with TEE, and inadequate support from the hospital or cardiology department.…”

Telemedicine and telesurgery in cancer care: Inaugural conference at MD Anderson Cancer Center

“…The clinical trials reported have demonstrated that telesurgery is feasible for assisting and/or mentoring by an expert, and remote teaching of simple procedures such as endoscopy [23]. Additionally, it is recommended that telesurgery should only be performed after considerable instruction and practice using the telesurgical systems involved [24,25]. This can be accomplished via a virtual surgical training simulator, cadavers, animal laboratory, or a mixture of all three [24,[26][27][28].…”