Robotic surgery training

Abstract

Robot-assisted surgery emerged in the 2000s and has grown almost exponentially in the last decade.The use of robotic-assisted surgery has increased 10-40-fold more than that of laparoscopic surgery for general routine procedures. 1 The continuous improvement of robotic platforms has allowed surgeons to overcome the limitations of conventional laparoscopy, such as 2D visualization and long instruments that do not accurately reproduce human wrist movements.Robotic systems provide high-definition 3D visualization, giving control of the camera to the surgeon.Robotic platforms have surgical instruments with intracavitary joints that reduce tremors, reproducing the movements of the surgeon on the console with great accuracy.Combined with these technical advantages, the clinical results consistently demonstrated in scientific articles seem to corroborate the great growth of robotic surgery in several specialties. 2 The increasing use of robotic systems has raised concerns about the safety of patients operated on by surgeons on a learning curve.This demand resulted in a standardized curriculum for training new surgeons.A few years ago, robotic training was controlled and certified by Intuitive, the company that manufactured the only robotic platforms then available in Brazil.The significantly increased demand for robotic surgery led the Brazilian Medical Association (AMB), the Specialty Societies, and the Federal Council of Medicine (CFM) to regulate robotic surgery in Brazil, establishing a structured training curriculum 3,4 consisting of a basic and an advanced stage.The basic or pre-clinical stage includes acquiring theoretical knowledge about robotic equipment and how the robot works, online training on the fundamentals of robotic surgery, watching videos and attending some robotic surgeries in person, training on a robotic simulator, and training on the robot console simulating real surgery movements and procedures (in-service training).In the advanced stage, the apprentice performs the robotic procedure as the main surgeon under the supervision of a surgeon-instructor (proctor) with extensive experience in the technique.After supervising at least ten specialty procedures, the proctor will be able to certify the apprentice surgeon's competence to perform robotic surgery.Next, we will describe the stages of the structured curriculum in more detail. ONLINE TRAININGThe Fundamentals of Robotic Surgery (FRS) is an online program on the principles of robotic surgery developed by more than 80 experts.Actually, it is not just an online program because it included other training stages.It is divided into an introduction to the robotic surgical system, didactic instructions on robotic surgical systems, psychomotor skills curriculum and training, communication skills training, and staff training.However, the program that is currently mostly used is the Technology Training Pathway, developed by Intuitive Surgical for its platform.This website provides videos and documents about the principles of the da Vinci system, especially about robotic instruments and accessories, port placement, docking, intraoperative configuration, surgical console manipulation, troubleshooting, and safety resources.