Robotic colorectal surgery training: Portsmouth perspective

Abstract

This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Keywords: Artificial intelligence; Colorectal surgery; Education; Robotics; Simulation training.

Fig. 1.

Use of the SCOPEYE headset (MediThinQ Co Ltd) by the bedside assistant during (A) robotic complete mesocolic excision and (B) total mesorectal excision. The assistant can use/change instruments, in an ergonomic way, without losing view of the surgical field, which is shown in 3-dimension.

Fig. 2.

Surgeons for Surgeons (SFS) App. (A) Opening screen. (B) Profile page (learning, events, and opportunities shared). (C) “Chat” page (specialty-based blog). (D) “Explore” page (video and case library). (E) “Cases” page (case description and discussion). (F) “Beyond surgery” page (open discussion to all the community).

Fig. 3.

The Surgical Vision Eureka (Anaut Inc) intraoperative real-time tissue and structures/organ overlay during a robotic low anterior resection. (A) Opening of the sigmoid mesentery at the sacral promontory. The blue lines show the connective tissue of the dissection planes, whilst the green lines show the hypogastric nerves descending into the pelvis. The Eureka shows 2 distinct dissection planes in blue; however, by showing the green lines, it alerts the surgeon to the correct dissection plane (above the nerves) and prevents nerve injury. (B) Mesocolic dissection caudal to the inferior mesenteric artery. The green lines show the complexity of the nerve fibers running along the planes. (C) Mediolateral dissection of the descending mesocolon. Eureka highlights the pancreas in yellow. (D) Posterior dissection plane during total mesorectal excision (TME). The blue lines show the connective tissue of the dissection plane, whilst the green lines show the hypogastric plexus nerves.