Robotic Surgery training during residency?

[MJB]

I was wondering which programs (especially DO Programs) are currently training residents on the DaVinci. I've tried to do some research and have found a few, but wondered if those currently in teaching facilities might be able to help a bit.

Anyone know which programs are currently offering this type of education?

Thanks in advance!

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[tootsweet]

All the programs I interviewed at (NorthEast) have resident involvement on the robot. In the least, residents help set up the arms and adjust them during surgery. Most programs had teaching consols or were getting them.

I did my subI at a program where more of the benign hysts and urogyn cases (on top of the gyn onc cases) were going to the Davinci so the residents were grumbling about "loosing" their cases, as they were not working the consol, rather, they were working as assistants. I think this is a very important issue and I wonder how it will affect resident training in the future. I am concerned that it will reduce the number of open and vaginal cases that the residents are primary surgeons on. Any more thoughts on this?

 

[Global Disrobal]

Look for programs such as Michigan and UNC where they have set up a structured Robotic teaching curriculum. The procedure is divided into portions and residents actively work on the console during specific portions. This might be a question best reserved for interview day.

Best of luck!

 

[MJB]

Thanks! I'm looking for places to do aways. I've found several programs now that appear to be training on the DaVinci. Just was a lot harder to find out than it should have been.

 

[jvarga]

There are a growing number of residencies that are now incorporating the robot into their programs. Finding these programs via a nationwide search will be very difficult. Regardless, here's a word of warning with seeking these programs out just for this reason. The robot is a great tool that offers lots of promise in select patients. However, it cannot and does not replace basic technique training and this has become very evident in those programs that use the robot. This dilemma is undergoing intense scrutiny to see the scope of the problem and to see how it's effects will be felt down the road. One recently published research article (December 2009 red journal) pretty much exposed this problem at a program in Michigan. My suspicion is that this very same problem will be encountered at any program that uses the robot. You will not get a better opportunity to learn and develop your basic skills than in residency, but you will have the rest of your career to learn the robot.

 

[tootsweet]

Anyone catch this a few weeks back? Almost every program I interviewed or rotated at touted their robot(s) The evidence just doesn't seem strong enough for residents to be losing bread and butter cases to the robot yet. One place I rotated at, some attendings were doing benign hysts with the DaVinci.


http://www.nytimes.com/2010/02/14/health/14robot.html?pagewanted=1&hp

 

[MJB]

I read that article the other day. It seemed "inconclusive" at best to me.

It seems the "evidence" they are using is very convoluted.

Robotic Surgeons need to get busy compiling their data and getting it out there, imo. I think, in the end, Robotic Surgery will win out. There are just too many benefits. Residents will obviously have to learn the basics first, but the possibilities with robotic procedures are pretty amazing.


http://mercy.com/news_show_local.asp?id=2565


Having observed both experienced and inexperienced surgeons at the console, it appears there is quite a difference between those who are proficient in robotic surgery and those who are not yet "highly experienced".

Shorter operating times (possible), much shorter hospitalizations, etc...

I like the benefits. My hope is that if this is my chosen field, that I'll be one that is able to become very proficient at all operations, including the robotic procedures when indicated.

 

[Diane L. Evans]

jvarga I agree with you. The robot does make suturing and complicated surgeries easier but you lose the hands-on experience one really needs to learn.

When you graduate many hospitals do not have the luxury of robotic surgery.

 

[pruritis_ani]

we have robotic training at our program. there are some pro's and con's, for sure. i think it is pretty key to imagine the future of robotics in gyn, and take it from there.

in my view (and based upon limited data, one study of which i authored), the robot offers limited quantifiable benefits. on similar patients, you will have increased OR time and similar complication rates. additionally, the costs are astronomically higher. without decreasing complications, OR time or hospital stays, how can you justify the huge intraoperative expense of the robot, the extra staff and the equipment?

theoretically, there may be an advantage as the experience levels increase, specifically with complicated dissections (think gyn onc cases or multiple previous surgeries) or suture heavy cases (think sacral colpopexy). however, in the real world, most general gyn's will not be performing these cases, therefore it is hard to justify spending a portion of the limited residency time working to learn a procedure that we likely will not ever perform.

in my view, a real potential future utilization of the robot would involve telesurgery. if you are a generalist in a remote area, or without subspecialist coverage, i can envision having a robot in your hospital, and a surgeon located remotely. as a generalist, you could dock the robot, assist the remote surgeon, close and take care of the pt postoperatively. however, whether this will occur is anyones guess. additionally, learning to dock and assist is not rocket science, and can be done easily while in practice.

what i learned over the last 4 years is this...robot cases are pretty tough to cover with residents (even with a specific curriculum and training course, as we have here). also, it seems low yeild training, as if you are going to be in a position to do robots, you will likely require fellowship training which should cover it in more detail. the appropriate use of robotics in gyn is far from being determined, but likely quite small. finally, even if you do robots in training, you still need to be certified by Intuitive Surgical (which, as far as I know, no residency training can get you) and credentialed by your hospital (which almost universally requires proctoring of at least 10 cases and institutional training).

so, while glamorous sounding, robotics in residency should not be a large part of the training. minimal exposure is certainlly adequate for what we do with it now.

 

[pruritis_ani]

I read that article the other day. It seemed "inconclusive" at best to me.

It seems the "evidence" they are using is very convoluted.

Robotic Surgeons need to get busy compiling their data and getting it out there, imo. I think, in the end, Robotic Surgery will win out. There are just too many benefits. Residents will obviously have to learn the basics first, but the possibilities with robotic procedures are pretty amazing.


http://mercy.com/news_show_local.asp?id=2565


Having observed both experienced and inexperienced surgeons at the console, it appears there is quite a difference between those who are proficient in robotic surgery and those who are not yet "highly experienced".

Shorter operating times (possible), much shorter hospitalizations, etc...

I like the benefits. My hope is that if this is my chosen field, that I'll be one that is able to become very proficient at all operations, including the robotic procedures when indicated.

I am not sure there are that many benefits to general gynecologists. The cases that we do with the robot are generally those that can be done with straight stick laparoscopy. Exceptions would be patients with severe adhesive disease or those procedures requiring suturing. Given the ease of use of cuff closure devices, benign hysterectomies can be done fairly easily in many cases with a laparoscope.

Hospital stays and complication rates for hysterectomies (benign and endometrial cancer) were the same in a small study I did. Pt populations were similar (the robot cases did tend to have larger uteri and higher BMI however).

I think the assumption that more can be done with a robot is premature in many cases, especially so with general gynecology. It currently does not open laparoscopy to a much wider population than is available to straight stick, there is no documented reduction in OR times or hospital stays (and a reduction from the 23 hour observation period in laparoscopy is not likely), complication rates are similar, and costs favor traditional laparoscopy (or in many cases vaginal surgery, but that is another discussion).

Oncology and urogynecology clearly have cases that may really benefit from a robot (ie the choice is robot or via laparotomy). But, I have yet to be convinced that general gynecologists have many current uses for the robot. However, if you have recently trained at a decent program, you should be a skilled enough laparoscopist to remove a uterus, tubes and ovaries with a scope. Why make it more expensive and time consuming without adding a benefit?