The Evolution of Robotic Surgical Training: A Short Communication on the Evaluation of Robotic Cardiac Surgery Simulation Training: A Randomized Controlled Trial

Abstract

Robotic cardiac surgery possesses great potential for both patient and societal benefits in regards to postoperative pain, infection rates, cosmesis, and earlier return to normal activity [1,2]. Despite these proven benefits, robotic cardiac surgery is offered at a relatively small number of institutions and has largely failed to be adopted by the majority of cardiac surgeons. There are several reasons explaining the reluctance to accept this new technology in cardiac surgery, including; aging surgeon demographics, high upfront and operating costs, scarcity of randomized trials, etc. Each of these factors plays an intricate and dynamic role in altering institution and surgeon perceptions and willingness to adapt to patient demands for minimally invasive techniques. Similar to the adoption of laparoscopic and thoracoscopic techniques in other specialties, robotics requires the acquisition of an entirely new skill set from traditional "open" operations. This learning curve unfortunately can be a difficult and anxiety provoking period for the institution, patient and surgeon, and can be fraught with higher rates of complications and adverse events. This is even more significant in robotics, as the high upfront investment of significant resources and increased operating costs, create little room for anything but exceptional clinical results and patient outcomes, as patients and institutions demand a return on their investments [3]. This fact may be, by far, the greatest barrier as to why robotics has failed to become more mainstream in cardiac surgery. Truly subspecialized centers of excellence in robotics are few and far between and consist mainly of a small number of early adopters of the technology. These centers have made the commitment to invest huge resources to get their programs off the ground, and then recruit large numbers of patients to provide a steady caseload in order to maintain and advance their surgical skills and abilities, and make a robotic surgery program financially viable at their center. At most institutions this is not possible. The reluctance of many surgeons and institutions to accept robotics is not solely due to the high upfront and operating costs (as all cardiac surgery operating rooms are expensive to initiate and keep running), but rather because of the steep learning curve that is associated with these non-traditional techniques, and the difficulty in achieving optimal patient outcomes during this process. In an age where coronary bypass and mitral valve surgery carries an operative mortality rate of ~2-3% (especially when patients are stratified for the low-risk individuals typically selected for robotic surgery), proving robotics to be a superior alternative to traditional sternotomy is a difficult task. No institution is going to invest millions of dollars up front and allow for early graft failures, high conversion rates, longer operating and cardiopulmonary bypass times and the potential for increased morbidity, mortality and inferior patient outcomes. No insurance company is g...

Implementation of Crisis-Resource-Management-based Team Training in Lower Austria

“…This is especially true for CRM-based team training on a simulator ( 18 , 19 ). As called for by David Gaba ( 20 – 22 ), medical simulation has become a regular part of training, especially in anaesthesiology: in Austria, simulation-based training has been mandatory since 2015. Despite this, so far, only a few of the bodies that operate healthcare institutions have responded and established obligatory simulation training for their staff.…”