Instruments and Techniques
Robotic Surgical Training Program in Gynecology: How to Train Residents and Fellows

Presented at the Joint Annual Meeting of the Council on Resident Education in Obstetrics and Gynecology and the Association of Professors of Gynecology and Obstetrics, March 4, 2010, Orlando, FL.
https://doi.org/10.1016/j.jmig.2010.11.003Get rights and content

Abstract

A protocol was established to standardize surgical training using the da Vinci Surgical System. Third- and fourth-year residents and first-year fellows in obstetrics and gynecology participated. The protocol includes online instruction and 2 hands-on modules: platform set-up and surgical skills. Platform set-up provides orientation to the console, visual platform, surgical cart (“robot”), camera set-up, port placement, and instrument insertion and removal. Surgical skills includes specific drills using rubber models that simulate human tissue: manipulation, dissection, and simple and advanced suturing. Performance times were recorded for each trainee, as well as previous robotic experience. Times were compared with goals established by Intuitive Surgical, Inc., to assess feasibility of this protocol and baseline robotic surgical aptitude. All trainees (n = 17) completed the training protocol. Performance times met goals for docking and dissection. These times also varied according to level of training. Performance times for manipulation and simple and advanced suturing were prolonged across all groups. Overall pass rates were 100% for docking, 90% for dissection, 11.8% for manipulation, and 0% for simple and advanced suturing. Dissection pass rates varied according to level of training. Performance times and pass rates were not improved with higher level of training or previous robotic experience. Resident and fellow instruction in new surgical technology is an important part of training in obstetrics and gynecology. Herein is reported a method to accomplish robotic training that standardizes instruction and assessment of skills.

Section snippets

Materials and Methods

Through the Computer and Robotic Enhanced Surgery (CARES) Center at the University of North Carolina at Chapel Hill (UNC-CH), a training curriculum was established to standardize both orientation to and surgical training using the da Vinci Surgical System (Intuitive, Inc., Sunnyvale, CA) for resident and fellow trainees in the Department of Obstetrics and Gynecology. All third- and fourth-year residents in the Department of Obstetrics and Gynecology and first-year fellows in the gynecologic

Results

All 7 third-year residents, all 6 fourth-year residents, and all 4 first-year gynecology fellows completed the 3 phases of the training protocol: the Online Training Module, the Docking Practicum, and the Surgical Skills Practicum. The online training module was a prerequisite to completing the Docking and Surgical Skills Practica. In assessing baseline aptitude, pass rates varied widely for each drill. The docking drill had the highest pass rate at 100%, followed by dissection and then

Discussion

Resident and fellow training in new surgical technology is an important part of a medical education curriculum. As new MIS technologies are introduced, clinical training must be adapted to meet these needs. Herein is described one method to accomplish robotic training that standardizes both instruction in and assessment of robotic surgical skills. An objective training protocol is important not only to instruct residents and fellows in robotic surgery but also for their credentialing in robotic

References (13)

There are more references available in the full text version of this article.

Cited by (32)

  • Robotic surgical training: Where are we?

    2016, Gynecologic Oncology
    Citation Excerpt :

    As a result, the need for a formal robotic training curriculum for gynecologic oncologists has never been greater. In 2011, Geller et al. published the results of a gynecologic-specific training program developed at the Computer and Robotic Enhanced Surgery center of the University of North Carolina, Chappell Hill (UNC) [27]. The program included third- and fourth-year residents and first-year fellows in all gynecologic subspecialties, although there was a major focus on gynecologic oncology.

  • Fellowship learning curve associated with completing a robotic assisted total laparoscopic hysterectomy

    2014, Gynecologic Oncology
    Citation Excerpt :

    Residency and fellowship training programs have started to incorporate robotic training into their surgical curriculums. A few institutions have proposed skill exercises and protocols for robotic training [4–6]; however, the optimal fashion to integrate robotic surgical training into residency/fellowship programs is yet to be determined. In a recent survey of 21 obstetric and gynecology program directors and 42 graduating residents, 0% of the directors and 2.8% of the residents reported being “completely prepared” to perform a robotic hysterectomy [7].

  • Successful incorporation of robotic surgery into gynecologic oncology fellowship training

    2013, Gynecologic Oncology
    Citation Excerpt :

    These statistics emphasize the importance of adequately educating fellows in the use of this new technology. Similar to reports from other institutions, the fellows in our program are required to go through a series of training steps prior to participating in robotic surgical cases [7,13]. First, they must complete the online training module provided by Intuitive Surgery.

  • Assessment of robotic simulation by trainees in residency programs of the southeastern section of the american urologic association

    2013, Journal of Surgical Education
    Citation Excerpt :

    Educators have yet to determine the optimal method of teaching robotic surgery to trainees. Training paradigms have been proposed, but most involve training during live surgery, which carries the risk of patient harm, especially early in the trainee learning curve.7,10,15 Training in this manner is also limited by surgeon availability and time as well as by medical legal risk to the supervising surgeon.

  • Analysis of Robotic Performance Times to Improve Operative Efficiency

    2013, Journal of Minimally Invasive Gynecology
View all citing articles on Scopus

Supported by an “Investments for the Future Grant” from the Computer and Robotic Enhanced Surgery (CARES) Center, University of North Carolina School of Medicine at the University of North Carolina at Chapel Hill.

Dr. Boggess is a consultant for Intuitive Surgical, Inc., Sunnyvale, CA.

View full text