Surgeons who follow a rigorous training protocol on a simulator have been found to have a significant advantage in performance on Intuitive Surgical's da Vinci robot compared with those who do not use a simulator, says a new study at The Icahn School of Medicine at Mount Sinai and Morristown Medical Center in New Jersey.
Board certified laparoscopic surgeons who had no experience with robotic surgery were able to meet and even exceed the rigorous requirements of the study set by a team of experienced robotic surgeons, each averaging over 75 robotic cases each year, according to researchers. Study participants required between eight and forty hours of simulation training to achieve the required benchmarks.
"Proficiency is something every novice robotic surgeon is looking for,” says study leader Dr. Patrick Culligan, M.D., FACOG, FACS, and professor of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine. "Our study has found that surgeons can become ready much more quickly by using the simulator, potentially saving time, blood loss, and costs for each hospital robotic program." The simulator’s software was developed by Mimic Technologies for the da Vinci robot and is sold by both Mimic and Intuitive Surgical.
The study involved 14 OB-GYNs and two sets of comparative benchmarks. The study’s “expert surgeons” each performed supracervical hysterectomies, as did a group of “control surgeons.” The control group had full robotic hospital privileges but was not averaging more than two cases per month and had not trained on the simulator. Operating time, estimated blood loss, and a blinded-skill assessment of videos were compared using t-tests for all cases across the three surgical groups.
"I believe that using validated simulation training, like Dr. Culligan's study demonstrated, is the way we all should be approaching training and credentialing in the future," says Dr. John Lenihan, Jr., medical director, Robotics and Minimally Invasive Surgery at Multicare Health Systems in Tacoma, Washington.
Those surgeons, who were engaged in their first-ever robotic surgery, who used the simulator, had a much better outcome than the control group, the investigators found. Compared to the control group, the surgeons trained with simulation completed their cases approximately 33 percent faster, had less blood loss, and scored better during the blind video review. Not only did the simulation trained surgeons achieve the benchmarks set by the experts, they did so quickly. Each surgeon was required to reach expert status on the simulator before they could move to performing a human hysterectomy.
“This landmark study has been used to establish a new training protocol, which is available through MShare, Mimic’s curriculum sharing portal,” says Jeff Berkley, founder and CEO of Mimic Technologies. “Anyone in the country who utilizes Mimic’s da Vinci simulator can use this new protocol to train surgeons to expert status quickly.”
Study surgeons, certified OB-GYN’s who had little to no experience with robotics, were given complete access to the robotic simulator and then completed the Intuitive Surgical introductory training course. They then performed their first ever robotic surgery – a supracervical hysterectomy. With senior robotic surgeons ready to step in if necessary, they used the dual-console da Vinci system to oversee the surgery.
“We are planning to incorporate this curriculum into our credentialing program for robotic surgeons,” said Dr. Paul Tulikangas, fellowship program director, Female Pelvic Medicine and Reconstructive Surgery at Hartford Hospital and associate professor, University of Connecticut School of Medicine. “This is a cost effective way to improve patient safety.”
"We found that the laparoscopic surgeons were just as proficient as the expert group and actually more proficient than the control group of fully credentialed robotic surgeons,” said Culligan. “In a relatively short amount of time the laparoscopic surgeons performed at expert levels. It was an exciting discovery.”