By: Jamie Loveland
Originally published in UPMC’s First Friday
Almost a decade ago, surgeons at UPMC began looking for better ways outside of minimally invasive surgery to achieve the same results as a traditional open approach for patients. They discovered they could use robotic surgery to perform complex procedures, resulting in very good patient outcomes. Robotic surgery uses computer-assisted, state-of-the-art technology to allow surgeons to perform procedures through small incisions with unmatched precision and control.
Over the next several years, UPMC surgeons published various high-profile articles showing that the robotic surgery approach is just as safe and feasible as traditional open surgery for the liver and pancreas. Robotic techniques were quickly adopted by other clinical specialties, and today, UPMC is one of the largest centers for robotic-assisted surgery in the United States.
The implementation of new technologies has always posed a challenge for physicians in every specialty. With robotic surgery, UPMC surgeons have found that the learning curve is quite steep.
“In surgical oncology, it took us almost 80 cases until we had things completely optimized. While patient outcomes were good, taking that length of time to learn these surgical techniques was not satisfactory,” said Herbert J. Zeh III, MD, chief, Division of Gastrointestinal (GI) Surgical Oncology, UPMC Cancer Center; co-director, UPMC Pancreatic Cancer Center; and co-director, UPCI GI Oncology Program. UPMC surgeons set out to develop a program that could teach techniques using a robot in a shorter period of time to other surgeons across the country and internationally. In 2014, the UPMC Center for Advanced Robotics Training (CART) was formed to do just that.
“Surgeons learn best when they have a comprehensive program. We wanted to create a mechanism by which we could more confidently train surgeons, and in turn, give them the confidence to adopt these skills and translate them into their own clinical practices,” said Umamaheswar Duvvuri, MD, director, Hand and Neck Robotic Surgery.
Currently the CART program is available in multiple specialties including ear, nose, and throat (ENT) surgery, thoracic surgery, surgical oncology, and cardiac surgery.
The intensive, hands-on course provides surgical teams training both on-site at UPMC facilities and virtually. From Florida to California, China to Belgium and the Netherlands, surgeons across the globe have participated in the program.
CART provides participating surgeons and their support staff with expertise through personalized pathways, much like private lessons in robotics. The program has two components: one introduces surgeons to robotic surgery who have no prior experience, the second helps those with robotics experience refine their skills.
Using a simulator, participants learn to use the robot much like pilots learn to fly. As they practice, the simulator gathers data that helps to track progress and determine how many more cases an individual may need before moving to the next step of the training program. Surgeons also practice by sewing on artificial organs or cadavers and then progress to watching video clips compiled from various surgical cases. Lastly, the training moves to the bedside, where surgeons are proctored and mentored by UPMC experts.
“The care of the surgical patient is so important, because there is little room for error. The days have passed where physicians are learning on patients. CART is providing physicians with an opportunity to work directly with our experts to take their skills to the next level,” said Dr. Duvvuri.
Engagement between participants and program experts continues long after the program has ended. UPMC experts are readily available to address questions and review cases; trainees are also able to return to UPMC to sit in on additional surgeries at any time. In some cases, UPMC experts will travel to other institutions to proctor surgeries, conduct lectures, and provide additional training.
Training the Whole Team
Though CART is focused on providing surgeons necessary technical skills, the program is unique in its emphasis on training surgical assistants and operating room nurses.
“Robotic surgery is a very intricate process. Someone is managing the patient and the robot itself. Having someone who is familiar and able to navigate between the two is critical. I go over the entire robotic system with the surgical staff – from pushing the power button on the robot to docking it. I explain how all of the different pieces work together,” said Jennifer Bonfili, BSN, robotics clinician.
UPMC operating room nurses also review what to do if there is a critical emergency, and how to go from doing a surgery robotically to traditionally, should the situation arise.
CART is a classic example of improving quality of care internally, as surgeons, nurses, residents, and fellows across a number of specialties within UPMC are currently participating in the CART program to help give our own patients the best possible, cutting-edge care.
A Paradigm Shift
Technology is always changing and there will always be new surgical devices and techniques. CART is leading the way when it comes to changing how surgeons think about incorporating new technology into practice.
Experts at UPMC want CART to serve as a prototype for the way surgeons are trained. By tracking the progress of trainees, UPMC experts hope this will show the tangible impact the program has on decreasing learning curves, heightening awareness of the culture of safety, and helping reduce complication rates.
“We don’t want surgeons to go back to trying to learn this on their own in the OR. Instead, this program should serve as a laboratory for how we train surgeons, both at UPMC and around the world,” said Dr. Zeh.