Effectiveness of a dedicated robot-assisted surgery training program

Abstract

Introduction: Robot-assisted surgery (RAS) has been integrated into the surgical armamentarium and generated wide-spread interest among practicing, non-robotic surgeons (NRS). While methods for training novice non-robotic surgeons have emerged, the effectiveness of these training programs has endured minimal scrutiny. This study aims to establish effectiveness of the RAST training program.

Materials and methods: A formal RAST program was established at Roswell Park Cancer Institute (RPCI) in 2008. From July 2010 to October 2012, 43 non-robotic surgeons participated in the program. The 1 to 4 week program included the validated fundamentals skills of robotic surgery (FSRS) curriculum, hands-on bedside trouble-shooting training, case observation with an expert robotic surgeon, hands on surgical training (HoST) procedure modules, da Vinci robotic surgical hands-on experience and finally a compulsory animal laboratory utilizing the da Vinci. As part of our training and credentialing quality assurance program, all participants were prospectively evaluated employing a survey. This survey aimed to evaluate the enduring impact of the RAST through time-sensitive interventions that allowed participants to reacclimatize themselves to their prospective practice as independently performing surgeons.

Results: The survey responses received from the participating NRS were collected over 27 months, with a response rate of 84%. The average follow up period post-RAST completion was 6 months (2-19). Overall, participants felt that the FSRS curriculum (81%), bedside trouble shooting (7%), and animal laboratory (53%) were beneficial program features that enabled NRS to become adequately acquainted with the basic principles of RAS. Approximately 5 weeks after RAST program completion, 64% of surgeons performed robot-assisted surgery. The two most commonly performed procedures were robot-assisted radical prostatectomy and gastrointestinal surgeries where eight surgeons performed independently while 12 performed procedures under the supervision of an expert robotic surgeon. The overall conversion rate to open was reported to be 1.3%.

Conclusions: A dedicated surgical training program focused on learning key steps of RAS enabled most participants to successfully incorporate and maintain their RAS skills in clinical practice.