Towards a democratization of robotic surgery education

Technological advances and their impact on the medical society force us to think of robotic surgery as the future of surgery. The use of robotic surgery aims to provide the surgeon with tools to face complex procedures with greater surgical skill.


What is the impact of robotic surgery in urology?


Currently, any laparoscopic surgery can be performed with robotic technology, especially difficult access procedures.


In the field of urology, several investigations indicate a positive impact of robotic surgery in the reduction of surgical time and intra- and postoperative complications in partial and radical nephrectomies, living donor, pyeloplasty, lithiasis surgery, etc.


Laparoscopy or robotic surgery?


In comparison with laparoscopy, robotic surgery is the technique that tends to be chosen to perform rigorous procedures that require greater precision, such as radical prostatectomy. In this regard, Dr. Juan Morote Robles, when contrasting the cost/benefit ratio, is of the opinion that in young patients, for example, it is more advisable to opt for robotic surgery, "The functional results with the robot are clearly superior to those obtained with conventional laparoscopy".

In view of this, we wonder if laparoscopy could be completely replaced by robotic surgery? Here it is interesting to analyze what Dr. Alexander Kutikov, urologist at the Fox Chase Center, states: "In trained hands, laparoscopic and robotic surgery would be equivalent; however, robotic surgery has a smaller learning curve and, therefore, reduces the barriers to access to minimally invasive surgery to remove the nephrons"


In view of the advantages of robotic surgery, such as three-dimensional vision, greater precision and speed of movements, reduction of hospitalization time and patient recovery, some negative elements of this technique have been identified: less tactile sensation of the tissue, longer surgical time. And, in turn, a major problem is the lack of economic resources in many regions or health centers, which turns out to be one of the main barriers to the acquisition and maintenance of robotic technology.


In conclusion, robotic surgery is very promising and has great advantages over laparoscopic surgery, but the latter will not be quickly replaced, since in certain cases it is also very beneficial and less costly.


What role does simulation play in learning robotic surgery?


The traditional technique of observation to emulate real surgical procedures is becoming a practice in disuse as a culture that prioritizes patient safety begins to take shape and forces surgeons to explore new learning methods.


In the medical field, as Jakimowickz (2011) points out, simulation provides the opportunity to accelerate the learning curve by repeatedly practicing in a controlled environment and without harming patients, the psychomotor skills necessary to perfect the surgeon's surgical skills.


Here you can see an example of how partial nephrectomies can be trained with robots!


Although the use of virtual reality is an alternative for learning, the lack of realism in the representation of organs and the various scenarios of complexity, as well as the inability to perceive a tangible object, lead to the search for alternatives. It is then when hyper-realistic siliconized phantoms become more relevant as they perfectly emulate the composition, texture and tissues of organs.


According to a study published in the Journal of Endourology (2015), dedicating 10 hours of training to junior and senior residents allows reaching an acceptable level of surgical competence in basic and advanced robotic surgery skills.


 

Interested in training at your medical institution?

Find out about upcoming hands-on courses in partial nephrectomy here
 


References:

Valero, R., Ko, Y.H., Chauhan, S., Schatloff, O., Sivaraman, A., Coelho, R.F., Ortega, F., Palmer, K.J., Sanchez-Salas, R., Davila, H., Cathelineau, X., & Patel, V.R.. (2011). Robotic surgery: history and impact on teaching. Actas Urológicas Españolas, 35(9), 540-545. https://dx.doi.org/10.4321/S0210-48062011000900006

Pereira Fraga, J. (2017). Actuality of robotic surgery. Cuban Journal of Surgery, 56(1). Retrieved from http://www.revcirugia.sld.cu/index.php/cir/article/view/489/237

Jakimowickz J, Jakimowickz C. (2011) Simulation in surgery, where are we and where will we go? Cir Cir; 79: 44-49.

Scott Wiener, Peter Haddock, Steven Shichman, and Ryan Dorin (2015) Building a urologic robotic surgery training curriculum: how many simulator sessions are required for residents to achieve competency. Journal of Endourology 29 : 11 , 1289-1293.

Hospital San Rafael (2015) "Functional results with the da Vinci are clearly superior to those obtained with conventional laparoscopy". Retrieved from: https://cirugiaroboticasanrafael.com/los-resultados-funcionales-con-el-da-vinci-son-claramente-superiores-a-los-obtenidos-con-laparoscopia-convencional/

Barons, James E. (2012) Comparing laparoscopic versus robotic partial nephrectomy. Journal of Urology. Retrieved from: https://www.intramed.net/contenidover.asp?contenidoid=76124