Shortening surgical training through robotics: randomized clinical trial of laparoscopic <i>versus</i> robotic surgical learning curves

Gall, Tamara; Alrawashdeh, Waleed; Soomro, NA; White, Steven A.; Jiao, Long R.

doi:10.1002/bjs5.50353

Cited by 30 publications

(16 citation statements)

References 17 publications

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“…In conclusion, robotic liver resection can be safely established within a manageable period. This seems to be due to a shorter learning curve for robotic when compared to laparoscopic surgery [30,31]. Whether the robotic technique is generally superior to the laparoscopic technique cannot be concluded based on our data.…”

Section: Discussionmentioning

confidence: 74%

Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years

et al. 2022

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Background While laparoscopic liver surgery has become a standard procedure, experience with robotic liver surgery is still limited. The aim of this prospective study was to evaluate safety and feasibility of robotic liver surgery and compare outcomes with conventional laparoscopy. Methods We here report the results of a single-center, prospective, post-marketing observational study (DRKS00017229) investigating the safety and feasibility of robotic liver surgery. Baseline characteristics, surgical complexity (using the IWATE score), and postoperative outcomes were then compared to laparoscopic liver resections performed at our center between January 2015 and December 2020. A propensity score-based matching (PSM) was applied to control for selection bias. Results One hundred twenty nine robotic liver resections were performed using the da Vinci Xi surgical system (Intuitive) in this prospective study and were compared to 471 consecutive laparoscopic liver resections. After PSM, both groups comprised 129 cases with similar baseline characteristics and surgical complexity. There were no significant differences in intraoperative variables, such as need for red blood cell transfusion, duration of surgery, or conversion to open surgery. Postoperative complications were comparable after robotic and laparoscopic surgery (Clavien–Dindo ≥ 3a: 23% vs. 19%, p = 0.625); however, there were more bile leakages grade B–C in the robotic group (17% vs. 7%, p = 0.006). Length of stay and oncological short-term outcomes were comparable. Conclusions We propose robotic liver resection as a safe and feasible alternative to established laparoscopic techniques. The object of future studies must be to define interventions where robotic techniques are superior to conventional laparoscopy.

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Section: Discussionmentioning

confidence: 74%

Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years

et al. 2022

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“…As discussed and increasingly evaluated in the literature, the learning curve of RAS and RAS experience play a significant role in its success and observed complication rates, as well as in relation to the operating time. Interestingly, a study of training time involving 42 participants found that less time was taken learning with RAS than with LA [ 55 ]. One robotic system, the Senhance ® surgical system, implements a new technology, referred to as haptic feedback [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Robotically Assisted Surgery in Children—A Perspective

Krebs

Schnorr

Heye³

et al. 2022

Children

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The introduction of robotically assisted surgery was a milestone for minimally invasive surgery in the 21st century. Currently, there are two FDA-approved robotically assisted surgery systems for use and development in pediatrics. Specifically, tremor filtration and optimal visualization are approaches which can have enormous benefits for procedures in small bodies. Robotically assisted surgery in children might have advantages compared to laparoscopic or open approaches. This review focuses on the research literature regarding robotically assisted surgery that has been published within the past decade. A literature search was conducted to identify studies comparing robotically assisted surgery with laparoscopic and open approaches. While reported applications in urology were the most cited, three other fields (gynecology, general surgery, and “others”) were also identified. In total, 36 of the publications reviewed suggested that robotically assisted surgery was a good alternative for pediatric procedures. After several years of experience of this surgery, a strong learning curve was evident in the literature. However, some authors have highlighted limitations, such as high cost and a limited spectrum of small-sized instruments. The recent introduction of reusable 3 mm instruments to the market might help to overcome these limitations. In the future, it can be anticipated that there will be a broader range of applications for robotically assisted surgery in selected pediatric surgeries, especially as surgical skills continue to improve and further system innovations emerge.

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“…It has been shown that the acquisition of surgical skills in a simulation setting takes less time with a robotic than with a laparoscopic platform. 112 Achieving technical proficiency has also been shown to take less time with robotic systems across an array of surgical procedures, including hepatectomies, colectomies and nephrectomies. [113][114][115] The faster acquisition of skills via robotic training is partly facilitated by high fidelity simulations available on the robotic consoles.…”

Section: Michal Kawka and Tamara Gallmentioning

confidence: 99%

Future of Surgery: Technology Enhanced Surgical Training: Report of the FOS:TEST Commission

Adebayo¹,

Aldoori²,

Allum³

et al. 2022

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Over the past 50 years the capability of technology to improve surgical care has been realised and while surgical trainees and trainers strive to deliver care and train; the technological ‘solutions’ market continues to expand. However, there remains no coordinated process to assess these technologies. The FOS:TEST Report aimed to (1) define the current, unmet needs in surgical training, (2) assess the current evidence-base of technologies that may be beneficial to training and map these onto both the patient and trainee pathway and (3) make recommendations on the development, assessment, and adoption of novel surgical technologies. The FOS:TEST Commission was formed by the Association of Surgeons in Training (ASiT), The Royal College of Surgeons of England (RCS England) Robotics and Digital Surgery Group and representatives from all trainee specialty associations. Two national datasets provided by Health Education England were used to identify unmet surgical training needs through qualitative analysis against pre-defined coding frameworks. These unmet needs were prioritised at two virtual consensus hackathons and mapped to the patient and trainee pathway and the capabilities in practice (CiPs) framework. The commission received more than 120 evidence submissions from surgeons in training, consultant surgeons and training leaders. Following peer review, 32 were selected that covered a range of innovations. Contributors also highlighted several important key considerations, including the changing pedagogy of surgical training, the ethics and challenges of big data and machine learning, sustainability, and health economics. This summates to 7 Key Recommendations and 51 concluding statements. The FOS:TEST Commission was borne out of what is a pivotal point in the digital transformation of surgical training. Academic expertise and collaboration will be required to evaluate efficacy of any novel training solution. However, this must be coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation. Currently, there is no replacement for hands-on operating. However, for future UK and ROI surgeons to stay relevant in a global market, our training methods must adapt. The Future of Surgery: Technology Enhanced Surgical Training Report provides a blueprint for how this can be achieved.

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Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves

Cited by 30 publications

References 17 publications

Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years

Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years

Robotically Assisted Surgery in Children—A Perspective

Future of Surgery: Technology Enhanced Surgical Training: Report of the FOS:TEST Commission

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