A Success Story from Nancy, France
The University of Nancy and the STAN Institute in Nancy, France, has been offering a variety of courses on robotic surgery since 2008. Under the watchful eye of Prof Jacques Hubert, the center has developed into one of the leading centers of robotic training in Europe if not the world.
Their focus has always been on ensuring enough time is spent on developing adequate psychomotor skills so that once a surgeon is at the console all they need to do is to focus on the procedure. The course is now a five day course and progresses through time spent on a micro surgery workstation, to a specified curriculum using a dV-Trainer by Mimic and eventually on to dry and wet labs with da Vinci system. The recent courses in December have attracted participants from as far away as China.
In robotic procedures, the console surgeon is un-scrubbed without direct access to the patient. They can only interact with the group through audio communication, whereas in conventional surgery, more than 80% of the information exchange is realized via visual contact. The success of robotic surgery thus relies on high-quality teamwork, wherein the bedside assistant plays an important role. Some surgeons are able to develop a close working relationship with the same first assistant but in many institutions the first assistant will be constantly changing with the rotation of the OR staff. This is an area that Dr Randy Fagin from the Texas Robotic institute has often talked about and how different surgical teams can have an impact on the efficiency of the OR by extending procedural times.
Towards the middle of 2014, Mimic launched its Xperience Team Trainer (XTT), a Laparoscopic trainer that can be attached to the da Vinci console emulator (dV-Trainer) and allows a console surgeon and first assistant to work together on the same simulated exercises. Not only can they work together but their performance can also be scored on an individual basis as well as a team basis.
Professor Hubert, having a strong research focus, first wanted to ensure that the device had training validity. He therefore carried out face, content, and concurrent validity testing to ensure that activities performed on the team trainer were equivalent to the similar tasks encountered in the real world. His research published online in Surgical Endoscopy shows this to be the case1. Hubert believed more research was needed to prove concurrent validity and felt that some improvement could be made in exercises and through the addition of haptics to the device. Sufficient changes were made to the system through the addition of extra exercises and the activation of the built in haptics for the STAN team to feel confident in including the team trainer as part of their December series of courses in 2015.
They decided to introduce a team training component to the course where the surgeons attending the course would each spend time as a console surgeon and also as a first assist. This is a realistic scenario as surgeons can frequently find themselves in a first assist role particularly when going through their residency training.
Overall Prof. Hubert and the STAN Institute felt that the Xperience Team Trainer was a valuable addition to their December course line up and felt that it highlighted the importance of vocal communication and team work between the participants. They also noticed that in some groups the console operator would give advice on focal depth while the student driving the laparoscopic device would provide force feedback on the patient side-assist activities.
“We have been very pleased with the inclusion of the Xperience Team Trainer into our course,” says Alexandre Thouroude, General Manager of the STAN Institute, “it has been very good at allowing users to develop an awareness of the importance of developing non–technical verbal skills and highlighting the importance of developing team and communication strategies.”
Mimic Technologies greatly values our partnerships with the STAN Institute and Prof. Hubert, as their input into Xperience Team Trainer has been of great benefit in improving the Xperience Team Trainer product further. We thank them for the continued support and partnership.
1 Face, content, construct, and concurrent validity of a novel robotic surgery patient-side simulator: the XperienceTM Team Trainer
Song Xu, Manuela Perez, Cyril Perrenot, Nicolas Hubert, Jacques Hubert
Surg Endosc. 2015 Dec 10. [Epub ahead of print]