In May, Mimic joined top urologists from around the world in attending the AUA Annual Meeting in Boston. Among the rich content and papers presented, here are 3 especially interesting robotic surgery training and simulation takeaways from papers presented at AUA 2017:
1. Trainees take between 15% and 120% longer than expert surgeons when carrying out procedural steps (Paper#MP51-04; Muammer Altok, Mary Achim, Surena Matin, Curtis Pettaway, John Davis, Houston, TX).
2. Novices position their arms in a less ergonomic fashion than expert surgeons (Paper#PD46-06; Kenta Takayasu, Kenji Yoshida, Tadashi Mastuda, Osaka, Japan).
3. Viewing a patient-specific simulated 3D model of a kidney tumor helped novices in identifying tumor locations (Paper#PD46-12; Rai et.al.).
1. A Decade of Robot-Assisted Radical Prostatectomy Training: Time-Based Metrics from Fellows and Residents (Paper# MP51-04, Muammer Altok, Mary Achim, Surena Matin, Curtis Pettaway, John Davis, Houston, TX)
A common way to train fellows is to allow them to carry out steps of the procedure and as they build up confidence, they eventually migrate to the complete procedure. This paper looked at the difference in time at various stages of the procedure between experts and novice surgeons and graded them by quartile. Overall fellows and residents were involved in 1,622 cases. The increase in time to complete the segments varied from 15% (E-PLND) to 120% (dorsal vein complex) depending on the part of the case being carried out as can be seen in the table below:
A Grade 4 to 5 success rate was achieved in 95% of the cases. Modern training in robot-assisted surgery is evolving towards curriculum-based training that includes didactics, dry-lab exercises, wet-lab operations, surgical assistance, and ultimately console performance under careful supervision. After a decade of training 4 clinical fellows and up to 12 residents per year, this study transformed their step-wise time metrics into a simple table to use to benchmark performance. A non-validated qualitative feedback was also recorded. Read the full study here.
2. Analysis of the Posture Pattern During Robotic Simulator Task Using Optical Motion Capture System (Kenta Takayasu, Kenji Yoshida, Tadashi Mastuda, Osaka, Japan)
This study was essentially looking to see if the relative position and movement of the shoulders, elbows, and wrists was different between novice and expert surgeons carrying out two Mimic simulation exercises. The table below shows there was in fact a significant variation:
We have often seen that there is a difference in economy of motion between expert surgeons but this is another way of looking at the same phenomena. In addition, there are differences between novices and experts in the positional relationship between the elbow and wrist and joint angle of the upper limb, indicating that experts may have less posture stress. Read the full study here.
3. Virtual Simulation Improves a Novice’s Ability to Localize Renal Tumors in 3D Physical Models – a Multi-institutional Prospective Randomized Controlled Study (Paper#PD46-12, Rai et al.)
This is an interesting paper that evaluates if bringing patient-specific 3D models into a simulated environment helps in identifying tumor location. One hundred medical students were put through the protocol below where they were exposed to a CT scan, half then looked at a 3D model on a dV-Trainer and half went to look straight at a physical model.
Those who had also looked at the 3D virtual representation on the dV-Trainer more accurately visualized the tumor location on the physical model. Read the full study here.
Focused on assisting hospitals to better maximize their investment in robotic surgery, Mimic has over 15 years of experience providing tools and support for robotic surgery training and program support. Contact us today to learn more.