Skip to main content

Advertisement

SpringerLink
Log in

Development and evaluation of a training module for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

With the increasing use of the surgical robotic system in the clinical arena, appropriate training programs and assessment systems need to be established for mastery of this new technology. The authors aimed to design and evaluate a clinic-like training program for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery.

Methods

Four trainees with different surgical levels of experience participated in this study using the da Vinci telemanipulator. Each participant started with an initial evaluation stage composed of standardized visceral and vascular operations (cholecystectomy, gastrotomy, anastomosis of the small intestine, and anastomosis of the aorta) in a porcine model. Then the participants went on to the training stage with the rat model, performing standardized visceral and vascular operations (gastrotomy, anastomosis of the large and small intestines, and anastomosis of the aorta) four times in four rats. The final evaluation stage was again identical to the initial stage. The operative times, the number of complications, and the performance quality of the participants were compared between the two evaluation stages to assess the impact of the training stage on the results.

Results

The operative times in the final evaluation stage were considerably shorter than in the initial evaluation stage and, except for cholecystectomies, all the differences reached statistical significance. Also, significantly fewer complications and improved quality for each operation in the final evaluation stage were documented, as compared with their counterparts in the initial evaluation stage. These improvements were recorded at each level of experience.

Conclusions

The presented experimental small and large animal model is a standardized and reproducible training method for robotic surgery that allows evaluation of the surgical performance while shortening and optimizing the learning-curve.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telementoring: review of early clinical results. Surg Endosc 16: 1389–1402

    Article  PubMed  CAS  Google Scholar 

  2. Ballantyne GH, Kelley WE Jr (2002) Granting clinical privileges for telerobotic surgery. Surg Laparosc Endosc Percutan Tech 12: 17–25

    Article  PubMed  Google Scholar 

  3. Berguer R (1999) Surgery and ergonomics. Arch Surg 134: 1011–1016

    Article  PubMed  CAS  Google Scholar 

  4. Bonatti J, Schachner T, Bernecker O, Chevtchik O, Bonaros N, Ott H, Friedrich G, Weidinger F, Laufer G (2004) Robotic totally endoscopic CAB: program development and learning curve issues. J Thorac Cardiovasc Surg 127: 504–510

    Article  PubMed  CAS  Google Scholar 

  5. Boyd WD, Desai ND, Kiaii B, Rayman R, Menkis AH, McKenzie FN, Novick RJ (2000) A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis Ann Thorac Surg 70: 839–842, discussion 842–843

    Article  PubMed  CAS  Google Scholar 

  6. Buess GF, Schurr MO, Fischer SC (2000) Robotics and allied technologies in endoscopic surgery. Arch Surg 135: 229–235

    Article  PubMed  CAS  Google Scholar 

  7. Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25: 1467–1477

    PubMed  CAS  Google Scholar 

  8. Cadiere GB, Himpens J, Vertruyen M, Bruyns J, Fourtanier G (1999) Nissen fundoplication done by remotely controlled robotic technique. Ann Chir 53: 137–141

    PubMed  CAS  Google Scholar 

  9. Cadiere GB, Himpens J, Vertruyen M, Favretti F (1999) The world’s first obesity surgery performed by a surgeon at a distance. Obes Surg 9: 206–209

    Article  PubMed  CAS  Google Scholar 

  10. Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, Pirozzi F, Caiazzo P (2005) Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 19: 117–119

    Article  PubMed  CAS  Google Scholar 

  11. Dakin GF, Gagner M (2003) Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems. Surg Endosc 17: 574–579

    Article  PubMed  CAS  Google Scholar 

  12. Damiano RJ Jr, Tabaie HA, Mack MJ, Edgerton JR, Mullangi C, Graper WP, Prasad SM (2001) Initial prospective multicenter clinical trial of robotically-assisted CAB grafting. Ann Thorac Surg 72: 1263–1268, discussion 1268–1269

    Article  PubMed  Google Scholar 

  13. Darzi A, Smith S, Taffinder N (1999) Assessing operative skill: needs to become more objective. BMJ 318: 887–888

    PubMed  CAS  Google Scholar 

  14. Degueldre M, Vandromme J, Huong PT, Cadiere GB (2000) Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study. Fertil Steril 74: 1020–1023

    Article  PubMed  CAS  Google Scholar 

  15. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165: 9–14

    Article  PubMed  CAS  Google Scholar 

  16. Di Lorenzo N, Coscarella G, Faraci L, Konopacki D, Pietrantuono M, Gaspari AL (2005) Robotic systems and surgical education. Journal of the Society of Laparoendoscopic Surgeons 9: 3–12

    PubMed  Google Scholar 

  17. Falk V, Diegler A, Walther T, Autschbach R, Mohr FW (2000) Developments in robotic cardiac surgery. Curr Opin Cardiol 15: 378–387

    Article  PubMed  CAS  Google Scholar 

  18. Gallagher AG, Richie K, McClure N, McGuigan J (2001) Objective psychomotor skills assessment of experienced, junior, and novice laparoscopists with virtual reality. World J Surg 25: 1478–1483

    Article  PubMed  CAS  Google Scholar 

  19. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM (2005) VR simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 241: 364–372

    Article  PubMed  Google Scholar 

  20. Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 91: 1390–1397

    Article  PubMed  CAS  Google Scholar 

  21. Hanly EJ, Marohn MR, Bachman SL, Talamini MA, Hacker SO, Howard RS, Schenkman NS (2004) Multiservice laparoscopic surgical training using the daVinci surgical system. Am J Surg 187: 309–315

    Article  PubMed  Google Scholar 

  22. Hanly EJ, Zand J, Bachman SL, Marohn MR, Talamini MA (2005) Value of the SAGES Learning Center in introducing new technology. Surg Endosc 19: 477–483

    Article  PubMed  CAS  Google Scholar 

  23. Hashizume M, Tsugawa K (2004) Robotic surgery and cancer: the present state, problems, and future vision. Jpn J Clin Oncol 34: 227–237

    Article  PubMed  Google Scholar 

  24. 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 learning curve of a simulated surgical task on da Vinci system. Surg Endosc 18: 372–378

    Article  PubMed  CAS  Google Scholar 

  25. Himpens J, Leman G, Cadiere GB (1998) Telesurgical laparoscopic cholecystectomy. Surg Endosc 12: 1091

    Article  PubMed  CAS  Google Scholar 

  26. Hubert J, Feuillu B, Mangin P, Lobontiu A, Artis M, Villemot JP (2003) Laparoscopic computer-assisted pyeloplasty: the results of experimental surgery in pigs. BJU Int 92: 437–440

    Article  PubMed  CAS  Google Scholar 

  27. Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18: 790–795

    PubMed  CAS  Google Scholar 

  28. Newlin ME, Mikami DJ, Melvin SW (2004) Initial experience with the four-arm computer-enhanced telesurgery device in foregut surgery. J Laparoendosc Adv Surg Tech A 14: 121–124

    Article  PubMed  Google Scholar 

  29. Niemeyer G, Kuchenbecker KJ, Bonneau R, Mitra P, Reid AM, Fiene J, Weldon G (2004) THUMP: an immersive haptic console for surgical simulation and training. Stud Health Technol Inform 98: 272–274

    PubMed  Google Scholar 

  30. Nifong LW, Chitwood WR Jr (2004) Building a surgical robotics program. Am J Surg 188 (4A Suppl): 16S–18S

    Article  PubMed  Google Scholar 

  31. Nio D, Balm R, Maartense S, Guijt M, Bemelman WA (2004) The efficacy of robot-assisted versus conventional laparoscopic vascular anastomoses in an experimental model. Eur J Vasc Endovasc Surg 27: 283–286

    PubMed  CAS  Google Scholar 

  32. Nio D, Bemelman WA, Boer KT, Dunker MS, Gouma DJ, Gulik TM (2002) Efficiency of manual versus robotical (Zeus)-assisted laparoscopic surgery in the performance of standardized tasks. Surg Endosc 16: 412–415

    Article  PubMed  CAS  Google Scholar 

  33. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2000) Assessment of the learning curve in health technologies: a systematic review. Int J Technol Assess Health Care 16: 1095–1108

    Article  PubMed  CAS  Google Scholar 

  34. Ro CY, Toumpoulis I, Ashton R Jr, Imielinska C, Jebara T, Shin SH, Zipkin J, McGinty J, Todd G, Derose J Jr (2005) A novel drill set for the enhancement and assessment of robotic surgical performance. Stud Health Tech Inform 111: 418–421

    Google Scholar 

  35. Ruurda JP, Broeders IA, Pulles B, Kappelhof FM, van der Werken C (2004) Manual robot-assisted endoscopic suturing: time-action analysis in an experimental model. Surg Endosc 18: 1249–1252

    Article  PubMed  CAS  Google Scholar 

  36. Ruurda JP, van Vroonhoven TJ, Broeders IA (2002) Robot-assisted surgical systems: a new era in laparoscopic surgery. Ann R Coll Surg Engl 84: 223–226

    PubMed  CAS  Google Scholar 

  37. Sarle R, Tewari A, Shrivastava A, Peabody J, Menon M (2004) Surgical robotics and laparoscopic training drills. J Endourol 18: 63–66, discussion 66–67

    Article  PubMed  Google Scholar 

  38. Stewart L, Way LW (1995) Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg 130: 1123–1128, discussion 1129

    PubMed  CAS  Google Scholar 

  39. Weiss H, Ortmaier T, Maass H, Hirzinger G, Kuehnapfel U (2003) A virtual reality–based haptic surgical training system. Comput Aided Surg 8: 269–272

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    A. Mehrabi, C. L. Yetimoglu, A. Nickkholgh, A. Kashfi, P. Kienle, L. Konstantinides, M. R. Ahmadi, H. Fonouni, P. Schemmer, H. Friess, M. W. Büchler, J. Schmidt & C. N. Gutt

  2. Department of Experimental Surgery, University of Heidelberg, Heidelberg, Germany

    M. M. Gebhard

Authors
  1. A. Mehrabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. L. Yetimoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Nickkholgh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kashfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Kienle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Konstantinides
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. R. Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Fonouni
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P. Schemmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. Friess
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. M. Gebhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. N. Gutt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Mehrabi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mehrabi, A., Yetimoglu, C.L., Nickkholgh, A. et al. Development and evaluation of a training module for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery. Surg Endosc 20, 1376–1382 (2006). https://doi.org/10.1007/s00464-005-0612-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0612-9

Keywords

Search

Navigation