Expert Robotic Surgeons Research Articles

Objective measures for longitudinal assessment of robotic surgery training

Current robotic training approaches lack the criteria for automatically assessing and tracking (over time) technical skills separately from clinical proficiency. We describe the development and validation of a novel automated and objective framework for the assessment of training. We are able to record all system variables (stereo instrument video, hand and instrument motion, buttons and pedal events) from the da Vinci surgical systems using a portable archival system integrated with the robotic surgical system. Data can be collected unsupervised, and the archival system does not change system operations in any way. Our open-ended multicenter protocol is collecting surgical skill benchmarking data from 24 trainees to surgical proficiency, subject only to their continued availability. Two independent experts performed structured (objective structured assessment of technical skills) assessments on longitudinal data from 8 novice and 4 expert surgeons to generate baseline data for training and to validate our computerized statistical analysis methods in identifying the ranges of operational and clinical skill measures. Objective differences in operational and technical skill between known experts and other subjects were quantified. The longitudinal learning curves and statistical analysis for trainee performance measures are reported. Graphic representations of the skills developed for feedback to the trainees are also included. We describe an open-ended longitudinal study and automated motion recognition system capable of objectively differentiating between clinical and technical operational skills in robotic surgery. Our results have demonstrated a convergence of trainee skill parameters toward those derived from expert robotic surgeons during the course of our training protocol.

Global Evaluative Assessment of Robotic Skills: Validation of a Clinical Assessment Tool to Measure Robotic Surgical Skills

We developed and validated a standardized assessment tool for robotic surgical skills, and report its usefulness, reliability and construct validity in a clinical setting. The Global Evaluative Assessment of Robotic Skills is a tool developed by deconstructing the fundamental elements of robotic surgical procedures in consultation with expert robotic surgeons. Surgical performance was assessed during robot-assisted laparoscopic prostatectomy on a 5-point anchored Likert scale across 6 domains. An overall performance score was derived by summing the ratings in each domain. Expert surgeons and postgraduate year 4 to 6 urology residents were evaluated to determine construct validity. Assessments were completed by the attending surgeon, a trained observer and the operator. A total of 29 evaluations of 25 trainees and 4 attending surgeons were completed. Experts scored significantly higher on the assessment than novice operators (p = 0.004). Postgraduate year 4 and 5 residents scored significantly lower than the expert group (p <0.05) while no difference was observed between mean performance scores of postgraduate year 6 trainees and attending surgeons (p >0.05). The internal consistency of the assessment tool was excellent (Cronbach's α = 0.90 to 0.93). The overall assessment score ICC among raters was 0.80 (95% CI 0.65-0.90). The Global Evaluative Assessment of Robotic Skills is simple to administer and able to differentiate levels of robotic surgical expertise. This standardized assessment tool shows excellent consistency, reliability and validity. Further study is warranted to evaluate its usefulness for surgical education and the establishment of competency in robotic surgery.

1336 DEVELOPMENT AND VALIDATION OF INANIMATE TASKS FOR ROBOTIC SURGICAL SKILLS ASSESSMENT AND TRAINING

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment1 Apr 20101336 DEVELOPMENT AND VALIDATION OF INANIMATE TASKS FOR ROBOTIC SURGICAL SKILLS ASSESSMENT AND TRAINING Alvin Goh, Rohan Joseph, Marcia O'Malley, Brian Miles, and Brian Dunkin Alvin GohAlvin Goh More articles by this author , Rohan JosephRohan Joseph More articles by this author , Marcia O'MalleyMarcia O'Malley More articles by this author , Brian MilesBrian Miles More articles by this author , and Brian DunkinBrian Dunkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a need for standardized, validated tasks to assess technical proficiency and optimize training on the robotic platform. Standard laparoscopic task training lacks the ability to discriminate skill level in the robotic setting. METHODS We used expert robotic surgeons to deconstruct the robot-assisted prostatectomy to identify technical skills essential to robotic surgical performance. A series of structured inanimate tasks were designed to progressively emphasize key cognitive and motor abilities, including elements singular to the robotic platform like clutch and camera control. Thirteen subjects, including 2 experts (involved in >30 robotic cases) and 11 novice surgeons, completed 4 training tasks. Overall performance and learning curves were measured using a scoring system developed to evaluate accuracy and efficiency. Face validity was assessed by a 9-point questionnaire. RESULTS Mean expert and novice performance scores (Figure 1) were significantly different for each inanimate training task (p <0.01). Experts consistently scored better than novices overall and following each successive trial (p<0.01). While improvement in performance was observed in the novice group with repetition, expert level was not reached (p<0.01). Expert performance remained stable over time. Subjects agreed the tasks were appropriately challenging and incorporated technical skills needed in robotic surgery. CONCLUSIONS We establish face and construct validity for a series of structured inanimate training tasks. Performance of inanimate tasks can be a marker for robotic technical skills. Our model may be useful in robot-assisted surgical training and evaluation. Houston, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGoh A, Aghazadeh M, Mercado M, Hung A, Pan M, Desai M, Gill I and Dunkin B (2018) Multi-Institutional Validation of Fundamental Inanimate Robotic Skills TasksJournal of Urology, VOL. 194, NO. 6, (1751-1756), Online publication date: 1-Dec-2015. Volume 183Issue 4SApril 2010Page: e516 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alvin Goh More articles by this author Rohan Joseph More articles by this author Marcia O'Malley More articles by this author Brian Miles More articles by this author Brian Dunkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-assisted laparoscopic pyeloplasty: outcomes reported by a centre with no previous laparoscopic experience

Laparoscopic pyeloplasty (LP) has proved to be an effective minimally invasive treatment for ureteropelvic junction obstruction (UPJO). However, its application is still limited by the challenge of the laparoscopic learning curve, which seems to be overcome by the recent introduction of robot assistance. The aim of this manuscript is to show our outcomes after the first robot-assisted laparoscopic pyeloplasties (RP) and critically evaluate the feasibility of this technique when performed by a surgical team without any previous laparoscopic experience. Between March 2005 and July 2008, 16 patients with UPJO underwent transperitoneal RPs. Before and after surgery patients were evaluated by ultrasonography, intravenous urography or retrograde pyelography, computed tomography (CT) scan, and/or diuretic renography. Mean follow-up was 16.8months. The assessed outcomes were mean operative time (OT), mean estimated blood loss (EBL), mean length of hospital stay (LOS), success (SR), and complication rates (CR). OT, EBL, LOS, and SR were 202min, 60ml, 5.2days, and 94%, respectively. Among the minor complications, two patients (12%) reported moderate abdominal pain while, concerning major complications, one patient (6%) developed ileus. Robot assistance was confirmed as a special tool for laparoscopic treatment of UPJO with excellent outcomes after a shorter learning curve. As shown by our results, the feasibility of RP may also be extended to naïve surgeons who can approach this technique even in the absence of previous laparoscopic training, rapidly attaining results similar to those reported by both laparoscopically experienced and expert robotic surgeons.