Teaching in the robotic environment: Use of alternative approaches to guide operative instruction

Green, Courtney; Chu, Simon; Huang, Emily; Chern, Hueylan; O’Sullivan, Patricia

doi:10.1016/j.amjsurg.2019.06.003

Cited by 17 publications

(12 citation statements)

References 36 publications

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“…Of the screened abstracts, 5638 did not meet inclusion criteria. A full‐text review was performed for 91 articles, of which 23 manuscripts met inclusion criteria and were included in the review [3–25].…”

Section: Resultsmentioning

confidence: 99%

The Current Evidence for Defining and Assessing Effectiveness of Surgical Educators: A Systematic Review

2020

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Background Surgical educator effectiveness is valued but lacks an operational definition. Clearly defining attributes consistent with effective surgical educators allows for the development of professional activities directed to nurture these qualities. Our aim was to identify the literature defining qualities of an effective surgical educator, and tools to measure effectiveness. Methods We searched PubMed, Medline, Scopus and Academic Search Complete for English language articles from 1 July 2009–1 July 2019. Two reviewers screened all abstracts for relevance and read full text of selected articles to identify included studies. Inclusion criteria were description/definition of an effective surgical educator or description of assessment/measurement of effectiveness in surgical educators. Data extracted included: study design, participants, definition/description of qualities of an effective surgical educator, qualitative or quantitative methods to assess surgical educators. Results Initial search identified 8086 articles. Of these, 2357 articles were excluded as duplicates and 5729 abstracts screened with 5638 excluded due to irrelevance. Full text review was performed for 91 articles to assess eligibility, 23 met inclusion criteria. The majority (74%) did not clearly define an effective surgical educator. Themes from six studies that determined important qualities include: communication, leadership skills, professionalism, respect, positive learning climate, and brief‐intraoperative teaching‐debrief model. One validated assessment tool was identified. Conclusions There is little published work defining or assessing effective surgical educators. Establishment of a positive learning climate and excellent communication skills continue to be important qualities that define surgical educator effectiveness.

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Section: Resultsmentioning

confidence: 99%

The Current Evidence for Defining and Assessing Effectiveness of Surgical Educators: A Systematic Review

2020

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“…The vast majority of surgical interventions are performed with one console and there is one principal surgeon, controlling the robotic arms and the camera. The physical distance between the operating surgeon and operative field creates a barrier that prevents a resident learner from appreciating how an attending's physical movements directly translate into the simultaneous tissue manipulation observed on the screen [ 24 ]. The learner often struggles to recreate these movements, while other physical barriers, such as screen size, arm placement and the lack of a haptic feedback may compromise the young surgeon’s experience and also decrease the trainers consent to give over control [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

An interdisciplinary team-training protocol for robotic gynecologic surgery improves operating time and costs: analysis of a 4-year experience in a university hospital setting

et al. 2021

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Main aim of this study is to assess the effect of a structured, interdisciplinary, surgical, team-training protocol in robotic gynecologic surgery, with the gradual integration of an advanced nurse practitioner. Data from all robotic surgical procedures were prospectively acquired. The surgical team consisted of one experienced surgeon and two surgical fellows and the scrub nurse team from three advance nurse practitioners, specialized in robotic surgery. The training was performed in a four-phase manner over 4 years and included theoretical training, hands-on training and team-communication skills enhancement. Scrub nurses increasingly adopted an active role during surgery. For a period of 4 years, 175 patients could be included in the analysis. All of them underwent a robotic gynecologic procedure. Mean docking time decreased from 45.3 to 27.3 min (p < 0.001), mean operating time from 235 to 179 min (p = 0.0071) and costs per case from 17,891 to 14,731 Swiss Francs (p = 0.035). There were no statistically significant changes in perioperative complications and conversions to laparotomy. An interdisciplinary long-term training protocol for high specialized robotic surgery within a “fixed” team with the gradually addition of an advanced study nurse improves the efficacy of the procedure in terms of time and costs. Although the surgery is performed quicker, the same performance and quality of surgical care could be reached.

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“…Another aspect is the more limited teaching techniques in RARP. A recent study analyzed instructional techniques used in robotic teaching environments [25]. They showed usage of a different set of instructional approaches compared to those used in open and laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic radical prostatectomy: difficult to start, fast to improve? Influence of surgical experience in robotic and open radical prostatectomy

et al. 2021

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Purpose The assistance of robotic systems raises the concern of whether there is an improved learning in robotic-assisted radical prostatectomy (RARP) compared to open retropubic radical prostatectomy (ORP). Methods We retrospectively analyzed data from 1438 patients who underwent ORP (n = 735) or RARP (n = 703). For each procedure, the level of experience of three different surgeons was summarized. Perioperative and pathological parameters reflecting surgical performance were compared between both learning curves. RARP data were influenced by new introduction of the robotic system. Results The median patient age at surgery was 66 years (IQR 42–80). Patients in the RARP group were younger (p < 0.001) and had a lower oncological risk (p < 0.001). Inexperienced RARP surgeons had a higher pT2-PSM rate and lower lymph node yield (13.8 ± 4.7 vs. 14.7 ± 4.8; p = 0.03) than inexperienced ORP surgeons. After 100 procedures, RARP and ORP surgeons had the same pT2-PSM rate (8% vs. 8%; p = 0.8) and lymph node yield (15.4 ± 5.4 vs. 15.4 ± 5.1; p = 1.0). In multivariate analysis for ORP, surgical inexperience (≤ 100 cases) was an independent predictor of a longer operating time (OR 9.0; p < 0.001) and higher amount of blood loss (OR 2.9; p < 0.001). For RARP, surgical inexperience (≤ 100 cases) was a predictor of a longer operating time (OR 3.9; p < 0.001), higher amount of blood loss (OR 1.9; p = 0.004), higher pT2-PSM rate (OR 1.6; p = 0.03), and lower lymph node yield (OR 0.6; p = 0.001). Conclusions Surgical experience has a relevant impact on perioperative and pathological parameters RARP has a higher initial pT2-PSM rate and lower lymph node yield than ORP. This is relevant for patient selection for novice teaching in RARP.

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Teaching in the robotic environment: Use of alternative approaches to guide operative instruction

Cited by 17 publications

References 36 publications

The Current Evidence for Defining and Assessing Effectiveness of Surgical Educators: A Systematic Review

The Current Evidence for Defining and Assessing Effectiveness of Surgical Educators: A Systematic Review

An interdisciplinary team-training protocol for robotic gynecologic surgery improves operating time and costs: analysis of a 4-year experience in a university hospital setting

Robotic radical prostatectomy: difficult to start, fast to improve? Influence of surgical experience in robotic and open radical prostatectomy

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