Building a Surgical Robotics Training Program: The Importance of Simulation

The Experience at Boston Children’s Hospital

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As a teaching hospital, Boston Children’s Department of Pediatric Urology has a strong commitment to training both residents and fellows with a heavy emphasis on minimally invasive surgery (MIS). About 60% of its MIS cases are done robotically, mainly Pyeloplastys and Partial Nephrectomies, and usually around 16 residents and 2 fellows are trained each year.

When exploring robotic surgery training options, the staff at Boston Children’s decided to invest in the dV-Trainer because it would be available 24 hours a day and could be located close to the operating room, but not necessarily in it. They also felt there was a strong need to provide a quantitative record of each trainee’s performance, which the dV-Trainer’s MScore scoring system provides.

Next, when building out the program, their training objectives were simple. First, they wanted to teach residents the foundational skills for robotic surgery, including instrument & tissue handling. Second, they believed it would be valuable to provide them with a protected, structured time for simulation education and to also provide supervised guidance during introductory training course. Finally, they wanted to offer comprehensive, individualized feedback using the standardized scoring system.

To achieve this, a structured curriculum was developed that included the following elements:

  1) Didactic components that include, Intuitive online training, AUA online – Urologic Robotic Surgery Course, FLS Training, and Video Library

2) Trainees would also be offered hands-on experience – bedside & console on the da Vinci, and simulation training using the dV-Trainer as well as components of team training

Ashley Wietsma (BCH Research Fellow 2014) was able to work with Todd Larson, Vice President & Chief Clinical Officer for MimicMED on developing a specific simulation curriculum that would meet Boston Children’s needs.

The final curriculum was divided into 6 sections including an introduction, warm up, pre-test, core, post-test and games that included approximately 20 exercises.

Since the system was acquired, 50% of the usage has been around the Boston Children’s curriculum. Twenty-five users have averaged over 80 sessions each with the power users doing significantly more than that.

“Providing training in a safe environment that helps improve handling and familiarity of the robotic console is critical,” says Richard Yu, Department of Urology, “skills such as camera control and clutching as well as developing muscle memory and improving hand-eye coordination while improving the non-dominant hand are all reasons why simulation is so important.”

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