Training in robotic thoracic surgery—the European way

Abstract

The increasing demand for robot-assisted thoracic surgery (RATS) in Europe requires a structured and standardized training module. Until now, Intuitive Surgical Inc. (Sunnyvale, CA, USA) has delivered the only available robotic surgery platform. Although the training program that is organized by Intuitive is divided in an initial and an advanced course, the success of the training depends on many external factors. Until now the training focused on experienced thoracic surgeons. The aim of this article is to offer a stepwise training module, which can be adopted by experienced open (thoracotomy) surgeons or video-assisted thoracic (VATS) surgeons but is primarily meant for thoracic surgery fellows and residents, as it is our sincere opinion that we should focus on training for this type of surgery as early in their careers as possible. In order to maintain surgical technique and minimize the chance of complications, ongoing training and certification of the surgeons and the team is deemed necessary.

Robotic-assisted thoracic surgery training in France: a nation-wide survey from young surgeons

“…A survey from the European Society of Thoracic Surgeons (ESTS) Robotic Working Group [ 5 ] highlighted the increasing adoption of RATS in Europe, but also emphasized significant gaps in training and curriculum integration across the continent. The importance of a structured, standardized training programme for thoracic robotic surgery in Europe has been acknowledged [ 12 ], and authors from Europe [ 3 , 12 ], the USA [ 13 , 14 ] and Australia/New Zealand [ 15 ] have expressed concerns about the lack of such programmes for various specialties [ 16 ]. In the USA, neither the American Association of Thoracic Surgery nor the Society of Thoracic Surgeons sponsors a widely accepted curriculum for residents, nor is robotic experience required to sit for American Board of Thoracic Surgery certification [ 17 ].…”

Suggested robotic-assisted thoracic surgery training curriculum

“…The application of robotic surgery in the field of thoracic surgery requires resident/fellow surgeons to be trained sufficiently in the field of robotic surgery by ensuring ample hands-on experience using robotic instruments through simulators (16). A proposal for a robotic thoracic surgery training program was presented by Shahin et al (17). The essential components of this proposal included ascertaining plans for implementation of robotic thoracic surgery in real life, providing trainees with a training plan in accordance with the specific period, providing trainees with a mentor, certifying the knowledge and skills gained while completing their training, designing and performing an evaluation program to assess the competency of trainees in robotic thoracic surgery after the completion of their training period, and developing a process of bilateral feedback.…”

Robot-assisted thoracic surgery for stages IIB–IVA non-small cell lung cancer: retrospective study of feasibility and outcome

“…The learning curve for surgery of more advanced disease is an ongoing, maybe never-ending, process. Patient selection is key, when a team is starting a new surgical technique and small peripheral tumors with prior induction therapy are the ones to start with [23]. In patients with advanced NSCLC, surgery was started as RATS and converted strategically when considered necessary.…”