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Surgical Endoscopy

, Volume 21, Issue 6, pp 912–915 | Cite as

Teaching robotic surgery: a stepwise approach

  • Mohamed R. Ali
  • Jason Rasmussen
  • Bobby BhaskerRao
Article

Abstract

Background

After an initial institutional experience with 50 robot-assisted laparoscopic Roux-en-Y gastric bypass procedures, a curriculum was developed for fellowship training in robotic surgery.

Methods

Thirty consecutive robotic gastric bypasses were performed using the Zeus robotic surgical system to fashion a two-layer gastrojejunostomy. For teaching purposes, performance of the anastomosis was divided into three discrete tasks. Robotic suturing tasks were assigned to the trainee in cumulative order in ten-case increments. Our patient population averaged 44 years of age and 47 kg/m2 in BMI. Patients were predominantly female (87%).

Results

The robotic training experience of the fellow defines the increases in surgical responsibility over the series of cases. Statistical analysis revealed no significant differences in task times or total robotic operative time as participation of the trainee in performing the gastrojejunostomy increased. No adverse robotic events or surgical complications occurred throughout this series. The learning curve of the fellow compared favorably with the initial experience of the institution.

Conclusion

Robotic surgery training may be safely implemented in a minimally invasive surgery training program. A gradual introduction of robotic technique appears to maximize the learning experience and minimize the potential for adverse outcomes.

Keywords

Gastric bypass Robotic surgery Education Obesity Bariatric 

References

  1. 1.
    Ali MR, Bhaskerrao B, Wolfe BM (2005) Robot-assisted laparoscopic Roux-en-Y gastric bypass. Surg Endosc 19: 468–472CrossRefPubMedGoogle Scholar
  2. 2.
    Artuso D, Wayne M, Grossi R (2005) Use of robotics during laparoscopic gastric bypass for morbid obesity. JSLS 9: 266–268PubMedGoogle Scholar
  3. 3.
    Bodner JC, Zitt M, Ott H, Wetscher GJ, Wykypiel H, Lucciarini P, Schmid T (2005) Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors. Ann Thorac Surg 80: 1202–1206CrossRefPubMedGoogle Scholar
  4. 4.
    Chang L, Satava RM, Pellegrini CA, Sinanan MN (2003) Robotic surgery: identifying the learning curve through objective measurement of skill. Surg Endosc 17: 1744–1748CrossRefPubMedGoogle Scholar
  5. 5.
    DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235: 640–647CrossRefPubMedGoogle Scholar
  6. 6.
    Fleck T, Tschernko E, Hutschala D, Simon-Kupilik N, Bader T, Wolner E, Wisser W (2005) Total endoscopic CABG using robotics on beating heart. Heart Surg Forum 8: 266–268CrossRefGoogle Scholar
  7. 7.
    Hernandez JD, Bann SD, Munz Y, Moorthy K, Datta V, Martin S, Dosis A, Bello F, Darzi A, Rockall T (2004) Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system. Surg Endosc 18: 372–378CrossRefPubMedGoogle Scholar
  8. 8.
    Herrell SD, Smith JA Jr (2005) Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 66: 105–107CrossRefPubMedGoogle Scholar
  9. 9.
    Higa KD, Ho T, Boone KB (2001) Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech 11: 377–382CrossRefGoogle Scholar
  10. 10.
    Lobe TE, Wright SK, Irish MS (2005) Novel uses of surgical robotics in head and neck surgery. J Laparoendosc Adv Surg Tech A 15: 647–652CrossRefPubMedGoogle Scholar
  11. 11.
    Mohr CJ, Nadzam GS, Curet MJ (2005) Totally robotic Roux-en-Y gastric bypass. Arch Surg 140: 779–786CrossRefPubMedGoogle Scholar
  12. 12.
    Moser F, Horgan S (2004) Robotically assisted bariatric surgery. Am J Surg 188: 38S–44SCrossRefPubMedGoogle Scholar
  13. 13.
    Narazaki K, Oleynikov D, Stergiou N (2006) Robotic surgery training and performance: identifying objective variables for quantifying the extent of proficiency. Surg Endosc 20: 96–103; erratum 20: 344CrossRefPubMedGoogle Scholar
  14. 14.
    Obek C, Hubka M, Porter M, Chang L, Porter JR (2005) Robotic versus conventional laparoscopic skill acquisition: implications for training. J Endourol 19: 1098–1103CrossRefPubMedGoogle Scholar
  15. 15.
    Oliak D, Ballantyne GH, Weber P, Wasielewski A, Davies RJ, Schmidt HJ (2003) Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc 17: 405–408CrossRefPubMedGoogle Scholar
  16. 16.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232: 515–529CrossRefPubMedGoogle Scholar
  17. 17.
    Schauer PR, Ikramuddin S, Hamad G, Gourash W (2003) The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 17: 212–215CrossRefPubMedGoogle Scholar
  18. 18.
    Talamini MA, Chapman S, Horgan S, Melvin WS (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17: 1521–1524CrossRefPubMedGoogle Scholar
  19. 19.
    Wittgrove AC, Clark GW (1999) Laparoscopic gastric bypass: A five-year prospective study of 500 patients followed from 3 to 60 months. Obes Surg 9: 123–143CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Mohamed R. Ali
    • 1
    • 3
  • Jason Rasmussen
    • 1
  • Bobby BhaskerRao
    • 2
  1. 1.Department of SurgeryUniversity of California, DavisSacramentoUSA
  2. 2.Desert HospitalPalm SpringsUSA
  3. 3.Department of SurgeryUniversity of California, DavisSacramentoUSA

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