Teaching and learning robotic surgery at the dual console: a video-based qualitative analysis

Hélène Cristofari,Nadja Niclauss,Christian Toso,Minoa Karin Jung,Laure Kloetzer

doi:10.1007/s11701-021-01224-5

Hélène Cristofari, Nadja Niclauss + Show 3 more

Open Access

https://doi.org/10.1007/s11701-021-01224-5

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Abstract

Robotic-assisted surgery (RAS) involves training processes and challenges that differ from open or laparoscopic surgery, particularly regarding the possibilities of observation and embodied guidance. The video recording and the dual-console system creates a potential opportunity for participation. Our research, conducted within the department of visceral surgery of a big Swiss, public, academic hospital, uses a methodology based on the co-analysis of video recordings with surgeons in self-confrontation interviews, to investigate the teaching activity of the lead surgeon supervising a surgeon in training at the dual console. Three short sequences have been selected for the paper. Our analysis highlights the skills-in-construction of the surgeon in training regarding communication with the operating team, fluency of working with three hands, and awareness of the whole operating site. It also shows the divergent necessities of enabling verbalization for professional training, while ensuring a quiet and efficient environment for medical performance. To balance these requirements, we argue that dedicated briefing and debriefing sessions may be particularly effective; we also suggest that the self-confrontation video technique may be valuable to support the verbalization on both the mentor’s and the trainee’s side during such debriefing, and to enhance the mentor’s reflexivity regarding didactic choices.

Highlights

The rapid expansion of robotic surgery over the past 15 years has increased questions regarding adequate training modes for surgeons
As noted by Kassite et al [10], there is no clear standard way to measure such a learning curve; some factors are rarely discussed in the robotic learning curve literature, such as patients’ outcome, intraoperative complications, the skill level of the assistant surgeon and other team members, the presence of a senior surgeon in the operating room, etc. [10]. Another difficulty is deciding who should be trained in robotic surgery [11, 12]: is it a specialty to be mastered when one is experienced in open and laparoscopic surgery, or should it be treated as a part of the general surgical toolkit, that should be familiar to everyone? This question is linked to an organizational issue, namely the presence or absence of a dedicated robotic team
The dual-console system creates a potential opportunity for participation

Summary

Introduction

The rapid expansion of robotic surgery over the past 15 years has increased questions regarding adequate training modes for surgeons. Robotic surgery raises specific issues with regard to training, compared to open or laparoscopic procedures. Hélène Cristofari and Minoa Karin Jung contributed to this work. Another difficulty is deciding who should be trained in robotic surgery [11, 12]: is it a specialty to be mastered when one is experienced in open and laparoscopic surgery, or should it be treated as a part of the general surgical toolkit, that should be familiar to everyone? This question is linked to an organizational issue, namely the presence or absence of a dedicated robotic team. Other institutions do not have dedicated robotic teams; this decreases exposure to robotic surgery [13, 14],

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