Training in Robotic Surgery Using the da Vinci® Surgical System for Left Pneumonectomy and Lymph Node Dissection in an Animal Model

Abstract

Objectives: In Japan, as of March 2010, only 13 hospitals were using the da Vinci system and only for selected cases. Few clinical robotic lung surgery has been done in Japan, and there are no standardized training programs, although some exist in the U.S. and are under consideration by the Japanese society for thoracic surgery. We have used the da Vinci S ® Surgical System for pneumonectomy and lymph node dissection in pigs. We report and review future possibilities and problems of robotic surgery, especially concerning education, training, safety management and ethical considerations for pneumonectomy and lymph node dissection in clinical practice. Methods: The da Vinci ® system consists of a surgeon's console connected to a patient-side cart, a manipulator unit with three instrument arms and a central arm to guide the endoscope. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transmit the surgeon's movements to the instrument arm. Results: We experienced exactly the same sensation as when performing standard open thoracotomy. Visual recognition is 3-D, and the high manipulation potential allows free movement of the various accessory instruments, exceeding the capacity of a surgeon's hands in video-assisted thoracic surgery (VATS) or even standard thoracotomy. Conclusions: Robotic surgery achieves at least the same level of operation technique for pneumonectomy and lymph node dissection under standard open thoracotomy, and it seemed as safe and easily performed as conventional VATS. The training program using pigs was effective and holds promise as a system to train thoracic surgeons in robotic lung surgery.

Swine model for training surgeons in minimally invasive anatomic lung segmentectomy

“…The importance of surgical training is increasing for younger surgeons, especially in minimally invasive operation (6). For thoracoscopic operative training, live swine models seem to be one of the methods for lung lobectomy in various countries, and they have been used in our country.…”

“…When introducing a new therapeutic method, appropriate training is important to ensure patient safety and the understanding of anatomical aspects, especially for younger surgical trainees (6). Therefore, we developed a swine model for anatomical thoracoscopic lung segmentectomy training.…”

Suggested robotic-assisted thoracic surgery training curriculum

“…Multiple thoracic surgery simulators are being used currently, including several animal and cadaveric models. Studies have demonstrated the effectiveness of animal and cadaveric models in robotic surgery training programs owing to their similarity to live human anatomy (22)(23)(24)(25).…”