Dual-console System Research Articles

Feasibility of initiating robotic surgery during the early stages of gastrointestinal surgery education.

Minimally invasive surgery for gastrointestinal cancers is rapidly advancing; therefore, surgical education must be changed. This study aimed to examine the feasibility of early initiation of robotic surgery education for surgical residents. The ability of staff physicians and residents to handle robotic surgical instruments was assessed using the da Vinci® skills simulator (DVSS). The short-term outcomes of 32 patients with colon cancer who underwent robot-assisted colectomy (RAC) by staff physicians and residents, supervised by a dual console system, between August 2022 and March 2024 were compared. The performances of four basic exercises were assessed after implementation of the DVSS. Residents required less time to complete these exercises and achieved a higher overall score than staff physicians. There were no significant differences in the short-term outcomes, operative time, blood loss, incidence of postoperative complications, and length of the postoperative hospital stay of the two surgeon groups. Based on the evaluation involving the DVSS and RAC results, it appears feasible to begin robotic surgery training at an early stage of surgical education using a dual console system.

Is Two Better Than One? A Retrospective Study on Colorectal Surgery Outcomes Using the Da Vinci® Dual-Console Robot.

The da Vinci® surgical system has become standard in many specialties. The dual-console system has increased console time for residents during their training. This study evaluated patient outcomes using the single- versus dual-console system in resident training. A retrospective case-control study was conducted of patients who underwent various colorectal surgeries using either the single- or dual-console da Vinci® system. Patient demographics, comorbidities, and outcomes were collected. Seventy-one patients (54.2%) utilized the single-console and 60 (45.8%) utilized the dual-console. There were no statistically significant differences in patient demographics, procedures performed, conversion to open, ICU admissions, total length of stay, need for blood transfusion, adequacy of surgical margin, number of lymph nodes harvested, anastomotic leak, discharge disposition, or readmission, wound infection, or need for reoperation within 30 days. There was a nonsignificant decrease in operative time with the dual-console system (200.6 vs. 220.2 minutes, p = 0.111). While this study showed no statistically significant differences between patient outcomes utilizing the single- versus dual-consoles, it showed that it is safe for use in training, and that more research is needed in this area.

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

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.

Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System.

Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.

Teacher and Trainee Learning Together—Dual Console and the 3 Arms

The purpose of this paper is to propose a method by which the trainer and the trainee can overcome their learning curves together. At a tertiary care facility where we have completely done away with the mandatory bedside procedure requirements, residents and fellows start all cases on the console and have graduated responsibilities assigned to them. Bedside assist cases were felt to take away from trainee precious console time when there were only on service for a limited period while providing laparoscopic skill training without any robot-specific experience. This is a cumulative experience of teaching residents and fellows under this system and its results. All trainees at a PG 3 level or greater were able to perform advanced hiatal dissection within 5 cases. The authors propose a paradigm that uses all 3 arms of the robot and a dual console system.

AB009. Robot-assisted laparoscopic psoas hitch with ureteric re-implantation for uretero-vaginal fistula following hysterectomy

Background: Robot-assisted procedures are expanding rapidly in minimally invasive urologic surgery. We demonstrate the use of da Vinci Xi dual console system for robotic-assisted psoas hitch with ureteral re-implantation.

Comparing Single and Dual Console Systems in the Robotic Surgical Training of Graduating OB/GYN Residents in the United States.

Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD) and residents (RES) towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4). Results. According to residents perception, dual console is utilized in about 70% of the respondents' programs. Dual console system programs were more likely to provide a robotics training certificate compared to single console programs (43.5% versus 0%, p = 0.03). A greater proportion of residents graduating from a dual console program perform more than 20 robotic-assisted total laparoscopic hysterectomies, 30% versus 0% (p = 0.15). Conclusions. Utilization of dual console system increased the likelihood of obtaining robotic training certification without significantly increasing the case volume of robotic-assisted total laparoscopic hysterectomy.

Comparison of Single and Dual Console Systems in the Robotic Surgical Training of Graduating Obstetrics and Gynecology Residents in the United States [103

INTRODUCTION: The use of robotic surgical systems in gynecologic surgery is continuing to increase. The dual console system has the potential to improve resident participation and training in robotic-assisted surgeries. The goal of this study is to compare obstetrics and gynecology residents' self-assessment of surgical training on single and dual console robotic systems. METHODS: An anonymous survey was designed using Qualtrics web-based survey software. The survey link was sent to all graduating obstetrics and gynecology residents and program directors in the United States by e-mail. RESULTS: A total of 39 program directors and 34 residents completed the survey. Thirty-one (70%) program directors and 26 (70%) residents reported that the dual console is being utilized in their institution. Thirty-six percent of program directors report that residents performed more than 20 robotic-assisted total laparoscopic hysterectomy cases in the dual console group compared with only 13% in single console group (P=.111), whereas 30% of residents in the dual console group report performing more than 20 robotic-assisted total laparoscopic hysterectomies compared with none in single console group (P=.124). Programs with a dual console had higher rates of providing training certificates at graduation: 52% (dual console group) compared with 22% (single console group) reported by program directors (P=.148) compared with 43% (dual console group) compared with 0% (single console group) reported by graduating residents (P=.032). CONCLUSION: Dual consoles are utilized in 70% of obstetrics and gynecology residency programs that completed the survey. Utilization of a dual console significantly increased the rate of obtaining training certificates as reported by residents. Utilization of a dual console did not significantly increase the number of robotic-assisted total laparoscopic hysterectomy cases performed by residents as reported by residents and program directors.

Dual-console robotic surgery compared to laparoscopic surgery with respect to surgical outcomes in a gynecologic oncology fellowship program

ObjectiveMinimally invasive surgical techniques decrease surgical morbidity and recovery time. Studies demonstrate similar surgical outcomes comparing robotic to laparoscopic surgery. These studies have not accounted for the incorporation of fellow education. With the dual-console da Vinci Si Surgical System®, a two surgeon approach could be performed. We sought to compare surgical outcomes at a gynecologic oncology fellowship program of traditional laparoscopic to robotic surgeries using the dual-console system. MethodsWe identified patients who underwent laparoscopic or robotic surgery performed by a gynecologic oncologist from November 2009–November 2010. Robotic surgeries were conducted using the dual-console, utilizing a two surgeon approach. Surgeries involved a staff physician with a gynecologic oncology fellow. Statistical analysis was performed using student t-test and chi-squared analysis. ResultsA total of 222 cases were identified. Cases were analyzed in groups: all cases identified, all cancer cases, and endometrial cancer cases only. When analyzing all cases, no statistical difference was noted in total operating room time (172 vs. 175min; p=0.6), pelvic lymph nodes removed (10.1 vs. 9.6; p=0.69), para-aortic lymph nodes dissected (3.7 vs. 3.8; p=0.91), or length of stay (1.5 vs. 1.3days; p=0.3). There was a significant difference in total surgical time (131 vs.110min; p<0.0001) and EBL (157 vs.94ml; p<0.0001), favoring robotic surgery. When analyzing all cancer cases, the advantage in total surgical time for robotic surgery was lost. Complications were similar between cohorts. ConclusionIncorporating fellow education into robotic surgery does not adversely affect outcomes when compared to traditional laparoscopic surgery.

Dual-console robotic surgery: a new teaching paradigm

Robotic surgery has emerged as an alternative option in minimally invasive gynecologic surgery. The development of the dual-console da Vinci Si Surgical System® has enabled modification of the training atmosphere. We sought to investigate operative times and surgical outcomes while operating with the dual-console model in a training environment for our first fifty cases. We identified the first fifty patients who underwent robot-assisted total hysterectomy (TRH), with or without bilateral salpingo-oophorectomy (BSO), with or without pelvic and para-aortic lymph node dissection (PPALND), by use of the dual-console robotic system. Records were reviewed for patient demographics and surgical details. All surgery was conducted using the dual-console system and performed by staff physicians and fellows. Operative time was calculated from robotic docking until completion of the procedure. Cases were identified from November 2009 through July 2010. Mean age was 56.2 years (SD 13.35, 95 % CI 52.46–59.86). Mean BMI was 29.5 (SD 7.67, 95 % CI 27.35–31.61). Seventy-eight percent of these patients were considered overweight, including 12 defined as obese (BMI 30–34.9) and 10 patients classified as morbidly obese (BMI ≥ 35). Surgery completed included PPALND alone (n = 1); radical hysterectomy (n = 1); TRH only (n = 3); TRH/BSO (n = 25); and TRH/BSO/PPALND (n = 20). Mean total operating room time was 188.8 min (SD 55.31, 95 % CI 173.45–204.11). Mean total surgical time for all cases was 118.1 min (SD 44.28, 95 % CI 105.87–130.41). Two vascular injuries were encountered, with one requiring conversion to laparotomy. These results compare favorably with historically reported outcomes from single-console systems. Utilizing the dual-console enables use of an integrated teaching and supervising environment without compromising operative times or patient outcomes.

Robotically Assisted Totally Endoscopic Coronary Bypass Surgery

Nearly all surgical disciplines have developed endoscopic operations over the last 2 decades that have become the standard of care. In cardiac surgery and specifically for coronary artery bypass grafting (CABG), the adoption of minimally invasive techniques was challenging for the following reasons: First, most procedures are already complex, and endoscopic approaches further increase the degree of complexity; second, the cardiac surgery community had until recently no endoscopic surgical tradition; and finally, early attempts to perform CABG with the use of conventional thoracoscopic instrumentation failed completely.1 Cardiac surgeons have standardized open operations for acquired heart disease, and despite low mortality and excellent results, CABG outcomes are heavily scrutinized. Consequently, the bar has been raised for any new competing technology, which has slowed its adoption. Robotic surgical technology was developed with the idea of performing remote operations and procedures in difficult spaces. These machines allow surgical maneuvers to be performed by instruments on robotic arms that are controlled by the operator from a console situated away from the operating table. This technology is well suited for completely endoscopic suturing inside the chest. In 1998, Loulmet et al2 performed the world's first totally endoscopic coronary artery bypass (TECAB) procedure using robotic assistance. The patient who received a single left internal mammary artery (IMA) to left anterior descending artery graft remains alive and free from angina 12 years postoperatively. During subsequent years, development has been slow but significant. TECAB developed from a single-vessel procedure to complex endoscopic robotic multivessel revascularization (Figure 1). The third generation of surgical telemanipulators is now available, with technological improvements in the areas of high-definition video, robotic arm mobility, instrument reach, surgeon comfort, and capability for intraoperative surgical endoscopic teaching with a dual-console system.3 Figure 1. Development of robotic totally endoscopic coronary artery bypass grafting from 1998 to …