Achieving proficiency: Mastering the learning curve

Initial robotic training

Obtaining adequate training to safely perform robotic operations varies based on surgeons’ skill and the technical nuances of each specialty and procedure. Adoption of any new technology requires a combination of guided- and self-directed learning on the part of the surgeon and team.

The first priority is understanding the fundamentals of the technology itself. Intuitive Surgical, Inc. offers robotic training and certification to all surgeons who are interested in learning and applying robotic surgery to their practice. During the first phase and introduction to the technology, surgeons review videos relevant to the procedures they plan to perform. The second phase of training involves online training modules that cover key concepts such as learning the basics of surgical energy and maneuvering the various components of the patient cart, console, and monitor, followed by an online assessment. The surgeons will then have a technology in-service with a da Vinci representative to get an overview of the system itself, a dry lab that teaches port placement, docking, and instrument exchange ( Fig. 3.1 ). The dry lab model also allows various skills drills, and, if available, the surgeon can then move on to simulation. The simulation includes tasks such as camera clutching and targeting, endo-wrist manipulation, energy and dissection, and needle control and needle driving with suturing skills. Once all of these skills are achieved the surgeons attend a 1- or 2-day training course that includes porcine or cadaveric labs. The surgeons may then attend live case observations. Thereafter, the surgeons will go on to complete their initial case series.

Simulation

An integral part of robotic training is the use of simulation. Surgical simulation allows trainees and surgeons to practice the basic skills necessary for learning robotic technology in a safe and controlled setting. These skills are potentially transferable to the operative setting. Simulation comes in different forms, the first being dry or inanimate lab exercises. These are used to focus on dexterity and control of the robotic instruments. These dry lab sessions can be repeated over time until proficient scores are achieved. Arain et al. demonstrated significant improvement and reliability of the performance among trainees. Virtual simulation models that offer a console similar to that used with the da Vinci system have also become widely available. An example of this is Mimic Technologies, which has produced software that integrates with the da Vinci console itself so that trainees can practice skills that utilize the actual technology. In addition to these simulation models, there are wet or cadaveric labs that provide experience with actual human or animal tissue to trainees, while allowing them to focus on the anatomy.