Console Experience Research Articles

Cross Sectional Survey of Ob/Gyn Residents’ Graduated Experience with Robotic Surgery

Study ObjectiveOb/Gyn resident experience with robotic gynecologic surgery has been evaluated at time of graduation, but no specific surgical procedures were identified to differentiate the experiences of residents at each level. This study proposes to determine which factors are correlated with more hands-on robotic surgery experience and resident satisfaction. DesignAn IRB-approved, 15-question survey was distributed electronically. 98 responses were received for a rate of 44%. Linear regression and ANOVA statistical analysis were performed. SettingCurrent residents at eight Ob/gyn residency programs in the US were surveyed. PatientsN/A InterventionsSurvey administration Measurement and Main ResultsThe majority of respondents were satisfied (48%) or had neutral feelings (20%) with regard to their robotic surgery experience. All respondents reported experience with uterine manipulation or bedside assisting by PGY2. Earliest experience performing hysterectomy was most common in PGY2 or PGY3.Seventy-six percent of PGY3 or PGY4 residents report operating on the console for some or all major robotic surgeries, with 69% having participated in greater than 20 robotic surgery cases during residency. Only exposure to MIGS faculty is significantly associated with high robotic surgery experience (p=.022).Overall satisfaction with robotic surgery experience increased significantly with higher level of participation (p<.0001), particularly operating at the console during some or most of the surgery; longitudinal experiences with hysterectomy, myomectomy, and salpingectomy/oophorectomy (p<.05); but not with solely bedside assisting or vaginal cuff closure. Factors limiting robotic console experience included case time constraints, lack of first assists, case complexity, and attending comfort. ConclusionsOb/Gyn resident satisfaction with training is significantly related to level and duration of robotic surgery participation. MIGS faculty contribute to more resident experience, and limiting factors include time constraints, case complexity and lack of first assists. These results can provide a framework for structuring resident training in robotic surgery.

Identifying barriers to resident robotic console time in a general surgery residency through a targeted needs assessment.

Robotic-assisted general surgery is experiencing exponential growth. Despite our institution's high volume, residents often graduate with inadequate console experience. Our aim was to identify the educational needs of residents and perceived barriers to residents' console time from both attendings and residents. Separate surveys were created and distributed to robotic surgery faculty and general surgery residents at our institution. Questions were a variety of modalities and focused on the robotic surgery experience at our institution, including barriers to resident console time from both attending surgeon and resident perspectives. Although residents' interest in robotic surgery exceeded that of open and laparoscopic surgery, confidence in their robotic skills was low compared to the other modalities. The top barriers to participating in robotic cases according to residents included minimal or no previous console time with the attending, lack of simulator time, and being required to perform bedside assistant duties. Faculty reported resident preparedness, prior robotic skill demonstration, simulator time, case complexity, and their own confidence as significant factors influencing resident console time. Using these results, we concluded that the design and implementation of a formal robotic surgery curriculum should incorporate simulation-based opportunities for residents to practice their skills, improve confidence, and increase console experience. In addition, simulation opportunities for faculty should also be considered to allow for improvement and maintenance of robotic surgical skills.

Residents perform better technically, have less stress and workload, and prefer robotic to laparoscopic technique during inanimate simulation.

With the widespread adoption of minimally invasive surgery, there is a growing need for surgical residents to be trained by a procedure-specific curriculum. This study aimed to evaluate the technical performance and feedback of surgical residents undergoing the robotic and laparoscopic hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) biotissue modules. A total of 23 PGY-3 surgical residents participated in this study and performed the laparoscopic and robotic HJ and GJ drills, which were recorded and scored by two independent graders using the modified objective structured assessment of technical skills (OSATS). After completing each drill, all participants filled out the NASA Task Load Index (NASA-TLX), Borg Exertion Scale, and Edwards Arousal Rating Questionnaire. Twenty-two (95.7%) residents had already received fundamentals of laparoscopic surgery certification. Eighteen (78.3%) residents had robotic virtual simulation training and the median (range) number of robotic surgery console experience was 4 (0-30). In the HJ comparison of the six OSATS domains, the robotic system was superior in Gentleness (p = 0.031). In the GJ comparison, the robotic system was superior in Time and Motion (p < 0.001), Instrument Handling (p = 0.001), Flow of Operation (p = 0.002), Tissue Exposure (p = 0.013), and Summary (p < 0.001). Participants answered significantly higher demand scores for laparoscopy on all six facets of NASA-TLX for both HJ and GJ (p < 0.05). The Borg Level of Exertion was > 2 points higher for laparoscopic HJ and GJ (p < 0.001). Residents rated more Nervousness and Anxiety for laparoscopic compared to robotic (p < 0.05) HJ and GJ. Additionally, when asked to score preference for robotic and laparoscopic approach in terms of technique and ergonomics, residents scored robot as better (laparoscopy worse) for both HJ and GJ in both domains. The robotic surgical system provided a more favorable environment for trainees with less mental and physical burden for minimally invasive HJ and GJ curriculum.

Prior Robotic Console Expertise May Improve Basic Skills at the New Hugo RAS Simulator: Results from a Cohort Trial and Implications for Skill Transference Across Platforms

BackgroundRobot-assisted surgery ensures minimal invasiveness; since the expiry of the Da Vinci patent, new robotic systems have entered the market. Recently, the Hugo RAS received CE approval for several surgical procedures. However, more is needed to know about skill acquisition at the new simulator. ObjectiveThis study aims to analyse the factors impacting basic surgical skills at the Hugo RAS simulator. Design, setting, and participantsWe present a cross-sectional study involving 71 participants of different backgrounds invited to a hands-on session with the Hugo RAS simulator voluntarily. All of them had no prior expertise with the system. Participants were recruited among medical/nurse students, residents, and laparoscopic and robotic surgeons. InterventionAll participants underwent a hands-on “pick and place” exercise at the Hugo RAS simulator; the metrics of a second-round pick and place exercise were recorded. Outcome measurements and statistical analysisMetrics were analysed with regard to the following variables: demographics, videogame use, and prior surgical experience (no surgical expertise, experience with laparoscopy, and experience with robotic console). Results and limitationsAll participants completed the test. Of them, 77.5% were naïve to surgery, 8.5% had prior laparoscopic expertise, and 14.1% had prior robotic console experience. The time to complete the pick and place exercise was significantly lower (p < 0.001) among prior robotic surgeons (38 s, interquartile range [IQR] 34–45) compared with both naïve participants (61 s, IQR 53–71) and laparoscopists (93 s, IQR 53–162). The overall score of the exercise decreased with age (p = 0.046); however, the overall scores were significantly and steadily higher among surgeons experienced in robotic consoles across all age groups (p = 0.006). Neither gender (p = 0.7) nor videogame use (p = 0.9) correlated significantly with the metrics. ConclusionsThis is the first study analysing factors impacting basic skill acquisition at a new robotic simulator. Experience with robotic consoles may represent a major factor, raising the hypothesis of the transferability of basic robotic skills across different robotic systems. Further studies are required to explore this issue. Patient summaryIn the present study, we analysed which characteristics may affect the basic surgical skills at a novel robotic platform.

A National Survey of Robotic Surgery Training Among Otolaryngology-Head and Neck Surgery Residents.

The aim of this study is to describe the current state of robotic surgery training among Otolaryngology-Head and Neck Surgery (OHNS) residency programs in the United States. This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. IV.

Quantifying the “Assistant Effect” in Robotic-Assisted Radical Prostatectomy (RARP): Measures of Technical Performance

Surgeons are reliant on the bedside assistant during robotic surgeries. Using a modified global rating scale (GRS), we aim to assess the association between an assistant's technical skill on surgeon performance in Robotic-Assisted Radical Prostatectomy (RARP). Prospective, intraoperative video from RARP cases at three centers were collected. Baseline demographic and RARP-experience data were collected from participating surgeons and trainees. The dissection of the prostatic pedicle and neurovascular bundle step (NVB) was analyzed. Expert analysts scored the console surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS), and the bedside assistant performance using a modified Objective Structured Assessment of Technical Skills (aOSATS). The primary outcome is the association between console surgeon performance, as measured by GEARS, and assistant skill, as measured by aOSATS. Spearman's rho correlations were used to test the relationship between assistant and surgeon technical performance, and a multivariable linear regression model was created to test this association while controlling for patient factors. 92 RARP cases were available for the analysis, comprising 14 console surgeons and 22 different bedside assistants. In only 5 (5.4%) cases, the neurovascular bundle step was completed by a trainee, and in 13 (14.1%) of cases, a staff-level surgeon acted as the bedside assistant. aOSATS score was significantly associated with robotic console experience (P=0.011), and prior laparoscopic experience (P<0.001). Assistant aOSATS score showed a weak but significant correlation with surgeon GEARS score during the neurovascular bundle step (spearman's rho=0.248, P=0.028). On linear regression, aOSATS remained a significant predictor of console surgeon performance (P=0.016), after controlling for patient age and BMI, prostate volume, tumor stage, and presence of nerve-sparing. This is the first study to assess the association between assistant technical skill and surgeon performance in RARP. Additionally, we have provided validity evidence for a modified OSATS global rating scale for training and assessing bedside assistant performance.

Assessment of Feedback Mechanisms in Robotic Surgery Curriculum in Obstetrics and Gynecology Residency

Study Objective Overcoming the learning curve in robotic surgery requires appreciable effort. A structured curriculum in robotic gynecologic surgery was established for residents at an academic teaching hospital. This study aimed to explore resident experience with robotic surgery and training and to elicit resident preferences for feedback within the curriculum. Design A survey assessing demographics, surgical preparation methods, robotic surgical experience and comfort, and feedback preferences was distributed electronically to current obstetrics and gynecology (OB/GYN) residents. Responses were analyzed with descriptive statistics. Setting This study was conducted in the OB/GYN residency at Northwestern University in Chicago, IL. Patients or Participants The survey was sent to the 47 current OB/GYN residents in the academic year 2019-2020. A total of 29 responses were elicited. Interventions N/A Measurements and Main Results Eighteen residents (18/29; 62%) reported console experience in at least one robotic surgery. Most (26/29; 90%) stated that prior to operating on the robotic console they felt uncomfortable or very uncomfortable. Prior to console experience, residents primarily used online videos (62%), VR simulation (48%) or observation of live surgery (48%) as preparation. Of note, 7 (24%) residents reported no preparation prior to robotic surgery; these were PGY1 or PGY2 residents who also reported no prior console experience. After console experience, ongoing preparation techniques remained similar, although more residents reported in engaging in pre-operative preparation. All reported that they do receive feedback on surgical skills, but perception of usefulness, timeliness, and structure varied. Feedback was reported as useful and timely, but not well-structured. Most residents (28/29, 97%) indicated that they would prefer real-time feedback immediately after console experience. Conclusion OB/GYN residents report that they are not comfortable with robotic surgery training. Current practices for preparation include self-directed activities, but they do not begin until after surgical console experience. This study demonstrates that early initiation of structured learning with feedback is necessary.

The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

To analyze the impact of the bedside assistant's experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon's experience. All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient's parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

Design and validation of a low-cost, high-fidelity model for robotic pyeloplasty simulation training

Owing to restrictions in operative experiences, urology residents can no longer solely rely on 'hands-on' operative time to master their surgical skills by the end of residency. Simulation training could help residents master basic surgical skills and steps of a procedure to maximize time in the operative room. However, simulators can be expensive or tedious to set up, limiting the availability to residents and training programs. The authors sought to develop and validate an inexpensive, high-fidelity training model for robotic pyeloplasty. Pyeloplasty models were created using Dragon Skin® FX-Pro tissue-mimicking silicone cast over 3-dimensional molds. Urology faculty and trainees completed a demographic questionnaire. The participants viewed a brief instructional videoand then independently performed robotic dismembered pyeloplasty on the model. Acceptability and content validity were evaluated via post-task evaluation of the model. Construct validity was evaluated by comparing procedure completion time, the Global Evaluative Assessment of Robotic Skills (GEARS) score, blinded subjective physical evaluation of repair quality (1-10 scale), and flow rate between experts and novices. In total, 5 urology faculty, 6 fellows, and 14 residents participated. The median robotic console experience among faculty, fellows, and residents was 8 years (interquartile range [IQR] = 6-11), 3.5 years (IQR = 2-4 years), and 0 years (IQR = 0-0.5 years), respectively. The median procedure completion time was 29min (IQR = 26-40min), and the median flow rate was 1.11mL/s (IQR = 0-1.34mL/s). All faculty had flow rates >1.25mL/s and procedure times <30min compared with 2 of 6 fellows and none of the residents (P<0.001). All faculty, half of the fellows, and none of the residents achieved a GEARS score ≥20, with a median resident score of 12.5 (IQR = 8-13) (P<0.001). For repair quality, all faculty scored ≥9 (out of 10), all fellows scored ≥8, and the median score among residents was 6 (IQR = 2-6) (P<0.001). The material cost was $1.32/model, and the average production time was 0.12 person-hours/model. This low-cost pyeloplasty model exhibits acceptability and content validity. Construct validity is supported by significant correlation between participant expertise and simulator performance across multiple assessment domains. The model has excellent potential to be used as a training tool in urology and allows for repetitive practice of pyeloplasty skills before live cases.

ЮМОР В ПРОСТРАНСТВЕ СОВРЕМЕННОЙ УКРАИНСКОЙ КУЛЬТУРЫ

An integral part of any person’s life is humor. It makes our life more attractive, it hides a huge potential of vitality, wherein humor is a risk zone, where it can be presented as something devastating and derogative.The last 4 years of the most difficult social and political processes of Ukrainian reality we can observe a splash of interest to humorous programs of various kinds. Several separate channels began its functioning by offering to view only comical and funny content. This phenomenon makes one to think about humor specifics, about necessity of interaction with the comic, about its importance not only for one person but for the whole country. Thus, the aim of the research is to determine the place of the humor in the contemporary Ukrainian culture.The humor subject is well represented in the history of the humanitarian sciences, however, due to the ambiguity of the subject of the study, this topic remains open for further researches. There are three main theories of humor, such as consolation theory, superiority theory and discrepancy theory. And each theory finds its own proponent.The main statement of the consolation theory is that humor is a way to cope with inner tension and the opportunity to get a pleasure from laughing. In the superiority theory the sense of satisfaction from the excellence while observing a fun person as a week, stupid, unsuccessful takes the first place. In the discrepancy theory the contrast between expected and real is important for understanding the humor nature, detecting the discrepancies of our ideas about things (concepts, categories) to its real embodiments, that in the end bring out the laugh. The success of the joke is the success of finding the hidden absurdity in it.Ukrainian science also provides some developments in this sphere. Annual scientific and theoretical conference devoted to the humor theme takes place in Odessa I. I. Mechnikov National University. The question of comical in human being and its cognition as well as forms of comical in literature and art are raised.To our mind, tragic social processes, which were taking place in Ukraine over the last 4 years, with no doubt lead to a rapid increase of society tension. In such conditions laugh is a good way to cope with negative consequences, as pointed in the consolation theory, humor and laugh are the opportunity to protect themselves painlessly, specifically Ukrainian society, from mental overload. As Freud pointed out, humor, irony and comic offer us a quick way not only to relieve tension, but also to get a pleasure, to live through the moment being happy. The moment of happiness and pleasure, the experience of consolation are the factors that determine the comical in the rank of priorities when choosing a particular discourse in conditions of the complex tragic situation.As any psychological protection the comical has two sides. To a certain moment, laugh is a relief from pain, as a result it becomes the cause of psychological anesthesia, the inability to fully experience the feelings and emotions that correspond to the situation context.However, this particularity of contemporary individual is connected not so with humor as with its overabundance. Also it is connected with overabundance of the information which is consumed in conditions of the informative society and society of consuming.On the other hand, humor supports Ukrainian society by contributing the stabilization of the social processes. Apparently, ironic discourse, which captured TV screens and Ukrainian YouTube, is the rescue for the Ukrainians and it proves one more time the ideas about consolation theory of humor.

MP01-18 QUANTIFYING THE ‘ASSISTANT EFFECT’ IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: MEASURES OF TECHNICAL PERFORMANCE

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2018MP01-18 QUANTIFYING THE ‘ASSISTANT EFFECT’ IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: MEASURES OF TECHNICAL PERFORMANCE Mitchell Goldenberg, Hossein Sadat, Jason Lee, Antonio Finelli, Rajiv Singal, and Teodor Grantcharov Mitchell GoldenbergMitchell Goldenberg More articles by this author , Hossein SadatHossein Sadat More articles by this author , Jason LeeJason Lee More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Rajiv SingalRajiv Singal More articles by this author , and Teodor GrantcharovTeodor Grantcharov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.124AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While robotic-assisted surgery provides several advantages to the surgeon, it also requires the surgeon to be reliant on the bedside assistant for various steps of the procedure. Despite the importance of their role, our ability to assess and understand the impact of the assistant on surgeon performance remains limited. We use modified global rating scales (GRS) to quantify the effect of assistant skill on surgeon technical performance during robotic-assisted radical prostatectomy (RARP). METHODS Prospective, intraoperative video from consecutive RARP cases at a quaternary cancer-referral center was collected. Baseline demographic and RARP-experience data was collected from participating surgeons and trainees. The dissection of the prostatic pedicle and neurovascular bundle step (PPNVB) was selected for analysis to quantify assistant performance. Expert analysts scored the surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS), and assistants were rated using a modified Objective Structured Assessment of Technical Skills (aOSATS) GRS, comprised of four of the seven OSATS domains. Kruskal-Wallis tests and Spearmans Rho correlations tested the relationship between aOSATS, previous experience, and surgeon technical performance. RESULTS A total of 34 RARP cases had complete surgeon and assistant assessment data for analysis. Four faculty and 10 trainee bedside assistants were included in the study. Surgeons had all completed more than 50 cases at the console at the time of the study. Trainee experience as bedside assist ranged from 0 to over 30 cases. aOSATS score was significantly associated with bedside experience (p=.001), console experience (p=.0.005), but not prior laparoscopic experience (p=.217). aOSATS score showed moderate positive correlation with surgeon GEARS score during the PPNVB step (0.533, p=.001), as shown in Figure-1. CONCLUSIONS This is the first study to assess the impact of assistant technical skill on surgeon performance in RARP. Additionally, we have provided validity evidence for a modified OSATS GRS for training and assessing bedside assistant performance. Our hypothesis-generating data suggests that bedside assistants must be technically skilled to allow the surgeon to perform at their best. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e10 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mitchell Goldenberg More articles by this author Hossein Sadat More articles by this author Jason Lee More articles by this author Antonio Finelli More articles by this author Rajiv Singal More articles by this author Teodor Grantcharov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V08-10 DESIGN AND VALIDATION OF A LOW-COST, HIGH-FIDELITY MODEL FOR RALP URETHROVESICAL ANASTOMOSIS

You have accessJournal of UrologyProstate & Renal Oncology II1 Apr 2018V08-10 DESIGN AND VALIDATION OF A LOW-COST, HIGH-FIDELITY MODEL FOR RALP URETHROVESICAL ANASTOMOSIS Brett Johnson, Matthew Timberlake, Igor Sorokin, Jeffrey Cadeddu, and Jeffrey Gahan Brett JohnsonBrett Johnson More articles by this author , Matthew TimberlakeMatthew Timberlake More articles by this author , Igor SorokinIgor Sorokin More articles by this author , Jeffrey CadedduJeffrey Cadeddu More articles by this author , and Jeffrey GahanJeffrey Gahan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1976AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical simulation is a critical component of surgical training, and urology trainees lack procedure-specific simulation models which allow repetitive practice of robotic skills during case preparation. We sought to develop and validate a low-cost, high fidelity robotic surgical simulator for the urethrovesical anastomosis component of robotic assisted laparoscopic radical prostatectomy. METHODS A novel urethrovesical anastomosis simulation model was constructed with silicone molds and a 3D-printed model of the male boney pelvis. Using a DaVinci surgical robot, urology faculty and trainees operated on the simulation. Each participant viewed a 4-minute instructional video and was then was given 12 minutes to complete the simulation. A survey was issued to establish face validity, content validity, and acceptability. Simulation runs were recorded, evaluated by three blinded reviewers, and given a GEARS (global evaluative assessment of robotic skills) and PACE (prostatectomy assessment and competency evaluation) score. The quality of the anastomosis was graded by two reviewers. These factors were compared to robotic experience to establish construct validity. ANOVA statistical analysis was performed. RESULTS Seventeen participants took part in the initial validation of this model (1 faculty, 4 fellows, 2 chief residents, and 10 residents). Median console experience was 10 years, 4.0 years, 1.5 years, and 0 years for faculty, fellows, chief residents, and residents, respectively. Likert (1-5) scores for face validity, content validity, and acceptability were 3.56 (SD 0.42), 4.17 (SD 0.21), and 4.24 (SD 0.15), respectively. Construct validity was excellent. Mean time to completion, mean percent completion, mean anastomosis inspection score, mean GEARS score, and mean PACE score all correlated to robotic experience (p < 0.01, see table 1). Total material cost was $2.50 per model. CONCLUSIONS We present a novel high-fidelity, low-cost robotic simulation of the urethrovesical anastomosis. Initial evaluation demonstrates good face validity, content validity, and acceptability. Construct validity is excellent, and the model is able to discern robotic skill level across all levels of training. Further studies are needed to evaluate longitudinal effect of the model on surgical training. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e822 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Brett Johnson More articles by this author Matthew Timberlake More articles by this author Igor Sorokin More articles by this author Jeffrey Cadeddu More articles by this author Jeffrey Gahan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evolving attitudes toward robotic surgery among Canadian urology residents.

Robotic-assisted laparoscopic surgery (RAS) has not been adopted as rapidly or widely in Canada as in the U.S. In 2011, Canadian urology residents felt that RAS represented an expanding field that could potentially negatively impact their training. We re-evaluate trainee exposure and attitudes to RAS in Canadian residency training five years later. All Canadian urology residents were asked to participate in an online survey designed to assess current resident exposure to and perception of RAS. The response rate was 39% (61/157). Seventy-seven percent of residents reported being involved in at least one RAS procedure (52% in 2011), and the majority had exposure to <10 cases. For those in hospitals with access to RAS, 96% desired more console time, while only 50% of those without access wanted more console experience. Of all residents, 50% felt that RAS will become the gold standard in certain urological surgeries (34% in 2011), but only 28% felt that RAS would play an increasingly important role in urology (59% in 2011). Despite an increase in exposure to RAS in residency programs over the past five years, console experience remains limited. Although these residents desire more access to RAS, many voice uncertainty of the role of RAS in Canada. We cannot conclude whether RAS is perceived by residents to be beneficial or detrimental to their training nationwide. Moving forward in the robotic era, it will be important to either modify residency curricula to address RAS experience or to limit RAS to fellowship training.

The appeal of sad music: A brief overview of current directions in research on motivations for listening to sad music

After happiness, sadness is the most common emotion attributed to music. A recent proliferation of research has provided intense focus on the reasons why sad music is so popular. The research presented in this paper aims to summarize the results of recent studies. The findings indicate that many people report that they choose to listen to sad music when experiencing sadness, and after experiencing negative events. A range of motivations have been found as to why people choose to listen to sad music, these include the role of music in; validating emotions, providing solace, providing rewarding emotional experiences, and aiding reflection and relaxation. For people who listen to sad music as an adaptive way to cope, some evidence in this review indicates that this may be a healthy strategy more applicable for psychologically healthy people, rather than those who are depressed or anxious. Findings indicate that depressed individuals, and ruminators, can use sad music adaptively, but also maladaptively. Sad music has also been shown to provide support when people are experiencing negative life events, as it enables the expression, identification, and understanding of the situation, which in turn aids the experience of consolation, and, ultimately, acceptance coping. Future directions for research, and the potential uses of sad music listening in therapeutic settings are discussed.

Consolation - An Unrecognized Emotion

Although consolation is one of the classic religious subjects it plays no role in the current debate about religious emotions. One reason for this neglect could be that this debate is mostly based on classical emotions such as joy and fear, love and hope, and that consolation is not understood as an emotion. This paper tries to show that consolation in fact can and should be seen as an emotion. After naming and refuting some reasons that speak against taking consolation to be an emotion, I will explain how consolation can be positively conceptualized as an emotion within a recent theory of emotions. It will be decisive to see that the experience of consolation can be understood not only hedonistically-qualitatively, but also intentionally. This structural conception allows for a differentiated description of various types of consolation as an emotion, also, in the tradition of William James, of a secular as well as a religious form of consolation.

Validity and Reliability of the Robotic Objective Structured Assessment of Technical Skills

Objective Structured Assessments of Technical Skills have been developed to measure the skill of surgical trainees. Our aim was to develop an Objective Structured Assessments of Technical Skills specifically for trainees learning robotic surgery. This is a multiinstitutional study conducted in eight academic training programs. We created an assessment form to evaluate robotic surgical skill through five inanimate exercises. Gynecology, general surgery, and urology residents, Fellows, and faculty completed five robotic exercises on a standard training model. Study sessions were recorded and randomly assigned to three blinded judges who scored performance using the assessment form. Construct validity was evaluated by comparing scores between participants with different levels of surgical experience; interrater and intrarater reliability were also assessed. We evaluated 83 residents, nine Fellows, and 13 faculty totaling 105 participants; 88 (84%) were from gynecology. Our assessment form demonstrated construct validity with faculty and Fellows performing significantly better than residents (mean scores 89±8 faculty, 74±17 Fellows, 59±22 residents; P<.01). In addition, participants with more robotic console experience scored significantly higher than those with fewer prior console surgeries (P<.01). Robotic Objective Structured Assessments of Technical Skills demonstrated good interrater reliability across all five drills (mean Cronbach's α 0.79±0.02). Intrarater reliability was also high (mean Spearman's correlation 0.91±0.11). We developed a valid and reliable assessment form for robotic surgical skill. When paired with standardized robotic skill drills, this form may be useful to distinguish between levels of trainee performance. II.

Construct Validation of the Key Components of Fundamental Skills of Robotic Surgery (FSRS) Curriculum—A Multi-Institution Prospective Study

Recent incorporation of simulation in surgical training necessitates developing validated platforms for training and assessment. A tool should fulfill the fundamental criteria of validation. To report the ability of a simulation-based robotic training curriculum-Fundamental Skills of Robotic Surgery (FSRS)-to assess and distinguish between different performance levels of operator experience (construct validity). This is a prospective multicenter observational study. Participants were classified as novice (0 robotic cases performed) and experts (>150 robotic cases performed). All participants were required to complete 4 key tasks in a previously validated FSRS curriculum: ball placement, coordinated tool control, fourth arm control, and needle handling and exchange. Using the metrics available in the simulator software, the performances of each group were compared to evaluate construct validation. A convenience cohort of 61 surgeons participated. Novice group (n = 49) consisted of 41 fellows/residents/medical students and 8 trained open/laparoscopic surgeons, whereas expert group consisted of 12 surgeons. The novice group had no previous robotic console experience, whereas the expert group had >150 prior robotic cases experience. An overall significant difference was observed in favor of the expert group in 4 skill sets (p < 0.05). Time to complete all 4 tasks was significantly shorter in the expert group (p < 0.001). The expert group displayed significantly lesser tool collision (p = 0.002) and reduced tissue damage (p < 0.001). In performing most tasks, the expert group's camera (p < 0.001) and clutch usage (p < 0.001) was significantly greater when compared with the novice group. The components of the FSRS curriculum showed construct validity. This validation would help in effectively implementing this curriculum for robot-assisted surgical training.

Assessment of Virtual Reality Robotic Simulation Performance by Urology Resident Trainees

To examine resident performance on the Mimic dV-Trainer (MdVT; Mimic Technologies, Inc., Seattle, WA) for correlation with resident trainee level (postgraduate year [PGY]), console experience (CE), and simulator exposure in their training program to assess for internal bias with the simulator. Residents from programs of the Southeastern Section of the American Urologic Association participated. Each resident was scored on 4 simulator tasks (peg board, camera targeting, energy dissection [ED], and needle targeting) with 3 different outcomes (final score, economy of motion score, and time to complete exercise) measured for each task. These scores were evaluated for association with PGY, CE, and simulator exposure. Robotic skills training laboratory. A total of 27 residents from 14 programs of the Southeastern Section of the American Urologic Association participated. Time to complete the ED exercise was significantly shorter for residents who had logged live robotic console compared with those who had not (p = 0.003). There were no other associations with live robotic console time that approached significance (all p ≥ 0.21). The only measure that was significantly associated with PGY was time to complete ED exercise (p = 0.009). No associations with previous utilization of a robotic simulator in the resident's home training program were statistically significant. The ED exercise on the MdVT is most associated with CE and PGY compared with other exercises. Exposure of trainees to the MdVT in training programs does not appear to alter performance scores compared with trainees who do not have the simulator.

Multidisciplinary validation study of the da Vinci Skills Simulator: educational tool and assessment device.

Despite the increased dexterity and precision of robotic surgery, like any new surgical technology it is still associated with a learning curve that can impact patient outcomes. The use of surgical simulators outside of the operating room, in a low-stakes environment, has been shown to shorten such learning curves. We present a multidisciplinary validation study of a robotic surgery simulator, the da Vinci(®) Skills Simulator (dVSS). Trainees and attending faculty from the University of Toronto, Departments of Surgery and Obstetrics and Gynecology (ObGyn), were recruited to participate in this validation study. All participants completed seven different exercises on the dVSS (Camera Targeting 1, Peg Board 1, Peg Board 2, Ring Walk 2, Match Board 1, Thread the Rings, Suture Sponge 1) and, using the da Vinci S Robot (dVR), completed two standardized skill tasks (Ring Transfer, Needle Passing). Participants were categorized as novice robotic surgeon (NRS) and experienced robotic surgeon (ERS) based on the number of robotic cases performed. Statistical analysis was conducted using independent T test and non-parametric Spearman's correlation. A total of 53 participants were included in the study: 27 urology, 13 ObGyn, and 13 thoracic surgery (Table1). Most participants (89%) either had no prior console experience or had performed <10 robotic cases, while one (2%) had performed 10-20 cases and five (9%) had performed ≥20 robotic surgeries. The dVSS demonstrated excellent face and content validity and 97 and 86% of participants agreed that it was useful for residency training and post-graduate training, respectively. The dVSS also demonstrated construct validity, with NRS performing significantly worse than ERS on most exercises with respect to overall score, time to completion, economy of motion, and errors (Table2). Excellent concurrent validity was also demonstrated as dVSS scores for most exercises correlated with performance of the two standardized skill tasks using the dVR (Table3). This multidisciplinary validation study of the dVSS provides excellent face, content, construct, and concurrent validity evidence, which supports its integrated use in a comprehensive robotic surgery training program, both as an educational tool and potentially as an assessment device. Table1 dVSS validation study participant demographic information Survey question Response Number (%) Gender Male 36 (67.9) Female 17 (32.1) Handedness Right-hand dominant 45 (84.9) Left-hand dominant 4 (7.5) Ambidextrous 3 (5.7) Level of training Junior Resident (R1-R3) 17 (32.1) Senior Resident (R4-R5) 12 (22.6) Fellow 16 (30.2) Staff Surgeon 8 (15.1) Specialty Urology 27 (50.9) ObGyn 13 (24.5) Thoracics 13 (24.5) Previous MIS experience (laparoscopic or thoracoscopic) None/minimal 17 (32.1) Moderate 11 (20.8) Significant 18 (34.0) Fellowship-trained in MIS 4 (7.5) Previous robotic surgery experience None 32 (60.4) Yes 21 (39.6) If yes, number of operative cases as surgical assistant 0 cases 33 (62.3) <10 cases 9 (17.0) 10-20 cases 3 (5.7) >20 cases 8 (9.4) If yes, number of operative cases at robotic console for at least 30min 0 cases 41 (77.4) <10 cases 6 (11.3) 10-20 cases 1 (1.9) >20 cases 5 (9.4) MIS minimally invasive surgery Table2 dVSS construct validity evidence dVSS exercise All subjects' overall score (%, mean±SD) Novice robotic surgeon overall score (%, mean±SD) Expert robotic surgeon overall score (%, mean±SD) p value Camera Targeting 1 69.943±21.7489 67.170±21.5258 91.667±4.2269 0.008 Peg Board 1 78.596±11.9824 76.913±11.6616 91.500±3.8341 0.004 Match Board 1 69.880±17.7691 67.864±17.9075 84.667±6.1860 0.028 Thread the Rings 74.152±16.4289 71.825±16.2605 89.667±5.8878 0.011 Suture Sponge 1 74.787±14.3086 73.171±14.5067 85.833±5.6716 0.042 Ring Walk 2 75.098±20.0861 73.333±20.1099 88.333±15.4100 0.086 Peg Board 2 84.308±11.7633 83.283±12.0861 92.167±3.6009 0.082 Table3 dVSS concurrent validity evidence NP time NP errors RT time RT errors Camera Targeting 1 overall score 0.471 (0.001) 0.083 (0.575) 0.291 (0.045) 0.061 (0.685) Peg Board 1 overall score 0.486 (0.001) 0.141 (0.344) 0.325 (0.026) 0.088 (0.555) Match Board 1 overall score 0.543 (<0.001) 0.096 (0.530) 0.295 (0.050) 0.215 (0.162) Thread the Rings overall score 0.432 (0.005) 0.231 (0.147) 0.533 (<0.001) 0.163 (0.310) Suture Sponge 1 overall score 0.592 (<0.001) 0.105 (0.509) 0.437 (0.004) 0.015 (0.925) Ring Walk 2 overall score 0.454 (0.002) 0.179 (0.234) 0.399 (0.006) 0.022 (0.884) Peg Board 2 overall score 0.675 (<0.001) 0.058 (0.696) 0.073 (0.626) 0.045 (0.762) Subjects' overall score for each dVSS exercise is correlated with the time to complete (time) and number of errors (errors) for the Needle Passing (NP) and Ring Transfer (RT) tasks performed using the dVR. Data is expressed as Pearson correlation coefficient (p value).

Transition from Resident Robotic Training Program to Clinical Practice: Robotic-Assisted Radical Prostatectomy Benchmark for Perioperative Safety

To analyze the perioperative safety and outcomes of the first 100 robotic-assisted radical prostatectomies (RARPs) performed by a resident trained surgeon entering directly into practice. Following a mentorship-based urology residency training program, the perioperative safety and outcomes of 100 consecutive RARPs were analyzed. Intraoperative complications, surgical pathology results, hospital course, and catheter removal times were all monitored. Urinary catheter time was considered prolonged if left in place for longer than 14 days. Surgical complications were scored using the Clavien grading system. The resident performed portions of 51 RARPs during the training program in resident years 2-5, including 17 as a chief resident under the guidance of a fellowship-trained robotic surgeon. One hundred RARPs were performed following residency training over a 17-month period (mean age, 60 years; mean body mass index, 29 kg/m(2)). Positive margin rate was 21%, and blood transfusion rate was 5%. Clavien grade 1-4 complication rates were 5%, 9%, 1%, and 1%, respectively. There was one intraoperative rectal injury and one conversion to an open operation. Five percent of patients required a urinary catheter longer than 14 days secondary to anastomotic leakage. There were no re-admissions or re-operations in the series. The current study serves as a benchmark for physicians entering practice directly from resident training. Mentorship-based residency programs and early console experience may be factors in contributing to perioperative safety and outcomes with newly trained physicians.