Monday, September 24, 2012

The effect of the robot on surgical education

Having taken an extended break from writing about the problems associated with robotic surgery, I think it’s time to explore an area not previously discussed.

What is the effect of the robot on surgical resident education?

The robot at the OR table (babe not included).
Let’s review a few points about robot-assisted surgery. The surgeon actually doing the case is not scrubbed. He sits at a console away from the patient and manipulates the instruments. Another doctor has to scrub and insert the instruments through small incisions and “dock” (connect the instruments) to the part of the robot that is next to the patient. 

The assistant at the patient’s side views the operation on a video screen. Sources tell me that residents get to do a lot of docking, observing, inserting and removing instruments and closing incisions but not much time, if any, at the console doing the operation.

There is a dual console capability but many hospitals do not invest in it because of the added cost of the fully equipped second console.
Two consoles. Resident (left) shown participating in the operation.

So how are the residents going to learn to perform surgery? There is already evidence that they lack confidence in their ability to operate independently. See my earlier blog on this subject.

The majority of graduating chief residents in surgery take at least one year of fellowship training. One can only hope that they train in a hospital that has at least one dual-console robot or they may end up practicing on you and me.


Josh said...

I have mixed feelings because I experienced both ends of the spectrum. I patiently docked instruments and watched the monitor (which was way more frustrating than usual because it was frequently the case that the attending surgeon on the robot wasn't all that facile with it either). But I also had a good attending who trusted us and let us do some of the case from the console, and those were amazing experiences. In this sense its actually not that different from open or laparoscopic surgery - some attendings are effective surgical educators and others aren't. It all goes back to one problem I have with surgical education: often the only criteria needed to be a surgical educator is a raised hand.

Skeptical Scalpel said...

Josh, well said. Just because the word "doctor" means teacher, it is assumed that we are all good at it. We are not.

T. said...

This is the fundamental reason why Intuitive invested into the simulator:

Skeptical Scalpel said...

T, I have some questions.

How many hospitals have bought simulators? How expensive is the simulator? Is simulation as good as doing the procedure on a patient (I don't think so)?

Anonymous said...

At my hospital the Surgical Technologist helps with the docking and inserts instruments and suction devises as well as grabbing tissue because we are not a teaching hospital and there are no residents in our hospital. I am being put into a position that I do not feel confident or skilled at because there are other Surgical Technologists that have no problem just doing what the Surgeon at the console tells them to do without proper training. I even went to my boss and the Intuitive Rep. and I was told all the other hospitals in our area are using Techs so I have to do what I have to do...What do you think about this dilemma?

Skeptical Scalpel said...

That's a good question. Do you insert ports for laparoscopic surgery? If yes, how is inserting the robotic equipment different?

I think that f you don't think you can safely do it, you should ask for some extra training. It's not a good feeling to do something you are not confident in your ability to do.

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