Robotic surgery

[Colonsay]

I'm wondering if anyone would be willing to comment on how residents are involved in robotic surgery in their programs. We're struggling with spending up to 9 hours in the OR at a time as bedside assistants without getting any real educational value or time on the console. What is the policy on residents assisting at robotic surgery at your institutions?

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[Pegsie]

We don't have a formal policy at our institution...it has been very rare for any assistants to spend that long in the OR on a robotic case, especially as our surgeons are getting faster at the robot, and we're getting faster at docking. I hate to say it, as much as I hated getting hit in the chest by the robot repeatedly, I do see some value in my past life as the 2nd assistant...I can troubleshoot the robot almost as well as the rep can these days. The only thing that flummoxes me now is if the robot just shuts off and we can't get it back on, ha ha.

Anyways. Basically, we don't have a formal policy. Usually somebody on the team notices that the poor resident has been scrubbed in forever and will offer to scrub them out. I don't necessarily see it being any different than 2nd assist on a lymphadenectomy where I'm retracting.

 

[anonperson]

I'm wondering if anyone would be willing to comment on how residents are involved in robotic surgery in their programs. We're struggling with spending up to 9 hours in the OR at a time as bedside assistants without getting any real educational value or time on the console. What is the policy on residents assisting at robotic surgery at your institutions?

It can be a variable experience where I'm at.

Interns are generally manipulating the uterus (essentially 2nd assist). As you progress, we generally are first assists and will help dock the robot. Depending on the attendings, some will have us sit at the console and perform portions of the case.

The use of the robot has been hit and miss in general in terms of resident education.


Are these 9 hour cases for benign gyn cases? That is fairly long to be honest. start to finish times are generally 2.5 hours for benign uncomplicated hysterectomies (This is skin to skin times).

I will say that a majority of the davinci cases could easily be done with traditional laparoscopy, LAVH, or TVH. I think its use is inappropriately high at this time as everyone is on the bandwagon for whatever reason. It does definitely have benefit in the morbidly obese patients etc.

 

[sia_simba]

Robotic surgery is cool, but may not be indicated for all types of gyn procedures.

For example, robotic cystectomy.

If you know laparoscopy, I think that is good enough. Unless if you are performing Radical hysterectomies daily.