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Robotic Pancreatoduodenectomy Biotissue Curriculum has Validity and Improves Technical Performance for Surgical Oncology Fellows

Published on Nov 1, 2017in Journal of Surgical Education2.209
· DOI :10.1016/j.jsurg.2017.05.016
Vernissia Tam5
Estimated H-index: 5
(University of Pittsburgh),
Mazen S. Zenati28
Estimated H-index: 28
(University of Pittsburgh)
+ 4 AuthorsMelissa E. Hogg17
Estimated H-index: 17
(University of Pittsburgh)
Abstract
Objective Obtaining the proficiency on the robotic platform necessary to safely perform a robotic pancreatoduodenectomy is particularly challenging. We hypothesize that by instituting a proficiency-based robotic training curriculum we can enhance novice surgeons’ skills outside of the operating room, leading to a shorter learning curve. Design A biotissue curriculum was designed consisting of sewing artificial organs to simulate a hepaticojejunostomy (HJ), gastrojejunostomy (GJ), and pancreaticojejunostomy (PJ). Three master robotic surgeons performed each biotissue anastomosis to assess validity. Using video review, trainee performance on biotissue drills was evaluated for time, errors and objective structured assessment of technical skills (OSATS) by 2 blinded graders. Setting This study is conducted at the University of Pittsburgh Medical Center (Pittsburgh, PA), a tertiary care academic teaching hospital. Participants In total, 14 surgical oncology fellows completed the biotissue curriculum. Results Fourteen fellows performed 196 anastomotic drills during the first year: 66 (HJ), 64 (GJ), and 66 (PJ). The fellows’ performances were analyzed as a group by attempt. The attendings’ first attempt outperformed the fellows’ first attempt in all metrics for every drill (all p Conclusion A pancreatoduodenectomy biotissue curriculum has face and construct validity. The curriculum is feasible and improves errors and technical performance. Time is the most difficult technical parameter to improve. This curriculum is a valid tool for teaching robotic pancreatoduodenectomies with established milestones for reaching optimum performance.
  • References (41)
  • Citations (13)
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References41
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#1Melissa E. Hogg (University of Pittsburgh)H-Index: 17
#2Vernissia Tam (University of Pittsburgh)H-Index: 5
Last. Herbert J. Zeh (University of Pittsburgh)H-Index: 61
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24 CitationsSource
#1Vernissia Tam (University of Pittsburgh)H-Index: 5
#2Herbert J. Zeh (University of Pittsburgh)H-Index: 61
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#1Andras B. FecsoH-Index: 4
#2Peter SzaszH-Index: 6
Last. Teodor P. GrantcharovH-Index: 47
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#1Jean-Pierre Faure (University of Poitiers)H-Index: 27
#2Cyril Breque (University of Poitiers)H-Index: 10
Last. Jean Pierre Richer (University of Poitiers)H-Index: 12
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Purpose In primary and continuing medical education, simulation is becoming a mandatory technique. In surgery, simulation spreading is slowed down by the distance which exists between the devices currently available on the market and the reality, in particular anatomical, of an operating room. We propose a new model for surgical simulation with the use of cadavers in a circulation model mimicking pulse and artificial respiration available for both open and laparoscopic surgery.
8 CitationsSource
#1Melissa E. HoggH-Index: 17
#2Mazen S. ZenatiH-Index: 28
Last. Herbert J. ZehH-Index: 61
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33 CitationsSource
#1Joshua S. Winder (Penn State Milton S. Hershey Medical Center)H-Index: 9
#2Ryan M. Juza (Penn State Milton S. Hershey Medical Center)H-Index: 6
Last. Jerome Lyn-Sue (Penn State Milton S. Hershey Medical Center)H-Index: 7
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The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014–2015. The curriculum consisted of online training, readings, b...
18 CitationsSource
#1David Pinzon (U of A: University of Alberta)H-Index: 1
#2Simon Byrns (U of A: University of Alberta)H-Index: 3
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Background. The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remai...
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Implementation of a robotic system may influence surgical training. The aim was to report the charge of the operating surgeon and the bedside assistant at robot-assisted procedures in urology, gynecology, and colorectal surgery.A review of hospital charts from surgical procedures during a 1-year period from October 2013 to October 2014. All robot-assisted urologic, gynecologic, and colorectal procedures were identified. Charge of both operating surgeon in the console and bedside assistant were r...
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#1Brian A. Boone (University of Pittsburgh)H-Index: 15
#2Mazen S. Zenati (University of Pittsburgh)H-Index: 28
Last. Amer H. Zureikat (University of Pittsburgh)H-Index: 29
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#1Behzad S. Farivar (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 1
#2Molly Flannagan (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 1
Last. I. Michael Leitman (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 13
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Introduction With the continued expansion of robotically assisted procedures, general surgery residents continue to receive more exposure to this new technology as part of their training. There are currently no guidelines or standardized training requirements for robot-assisted procedures during general surgical residency. The aim of this study was to assess the effect of this new technology on general surgery training from the residents’ perspective. Methods An anonymous, national, web-based su...
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The lack of haptic feedback in Robot-assisted Minimally Invasive Surgery (RMIS) is a potential barrier to safe tissue handling during surgery. Bayesian modeling theory suggests that surgeons with experience in open or laparoscopic surgery can develop priors of tissue stiffness that translate to better force estimation abilities during RMIS compared to surgeons with no experience. To test if prior haptic experience leads to improved force estimation ability in teleoperation, 33 participants were ...
#1Richard S. Hoehn (University of Pittsburgh)
#1Richard S Hoehn (University of Pittsburgh)
Last. Amer H. Zureikat (University of Pittsburgh)H-Index: 29
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BACKGROUND: Robotic pancreatic surgery is expanding throughout centers across the country. We investigated national trends in the use and outcomes for robotic-assisted pancreaticoduodenectomy (RPD) and distal pancreatectomy (RDP) for primary pancreatic tumors. METHODS: The National Cancer Database was queried for RPD and RDP performed during three time periods: 2010-2012, 2013-2014, and 2015-2016. These time periods were compared for patient and center factors as well as surgical outcomes. RESUL...
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#1Charles Christian Vining (U of C: University of Chicago)
#2Melissa E. Hogg (NorthShore University HealthSystem)H-Index: 17
Training for minimally invasive pancreas surgery is critical as an evolving body of literature supports its use with acceptable outcomes during training and improved short term outcomes following completion. Although case volume needed to achieve mastery remains unclear, improved outcomes for both laparoscopic and robotic pancreatectomy are demonstrated following a learning curve and inflection point. Therefore, dedicated training curricula for both laparoscopic and robotic pancreatectomy have b...
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#1Patrick R. Varley (University of Pittsburgh)H-Index: 6
#2Amr Al-abbas (University of Pittsburgh)H-Index: 2
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Though minimally invasive approaches have been readily incorporated into many areas of oncologic surgery, their use for pancreaticoduodenectomy (PD) has been less widespread. However, with the introduction of a robotic platform, surgeons have been able to overcome the technical challenges that limited the adoption of laparoscopic PD. Robotic PD (RPD) can now be performed with the same safety and oncologic outcome profile as open PD and is the preferred surgical approach in our institution. Here,...
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#1A. Moekotte (UvA: University of Amsterdam)H-Index: 1
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Abstract Background Minimally invasive pancreas resection (MIPR) has been expanding in the past decade. Excellent outcomes have been reported, however, safety concerns exist. The aim of this study was to define prerequisites for performing MIPR with the objective to guide safe implementation of MIPR into clinical practice. Methods This systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). PubMed, Emba...
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#1Aashay Vaidya ('KCL': King's College London)
#2Abdullatif Aydin ('KCL': King's College London)H-Index: 14
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Abstract Background Tools for assessment of technical skills are a crucial part of surgical education. They provide trainees with quantitative feedback highlighting both proficiency and areas for improvement. For this to be relevant to day-to-day practice, the tools used have to be validated and relevant to each surgical situation. This study aims to evaluate the validity of assessment tools used within surgery. Materials and methods Following Preferred Reporting Items for Systematic Reviews and...
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#1Maurice J. Zwart (UvA: University of Amsterdam)H-Index: 3
#2Ignacio Fuente (Hospital Italiano de Buenos Aires)H-Index: 3
Last. L.A. Stibbe (UvA: University of Amsterdam)
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Abstract Background It is currently unclear what the added value is of 3D-laparoscopy during pancreatic and biliary surgery. 3D-laparoscopy could improve procedure time and/or surgical performance, for instance in demanding anastomoses such as pancreatico- and hepaticojejunostomy. The impact of 3D-laparoscopy could be negligible in more experienced surgeons. Methods We conducted a randomized controlled cross-over trial including 20 expert laparoscopic surgeons and 20 surgical residents from 9 co...
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#1MaryJoe K. Rice (UMB: University of Maryland, Baltimore)
#2Mazen S. Zenati (University of Pittsburgh)H-Index: 28
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OBJECTIVE Providing feedback to surgical trainees is a critical component for assessment of technical skills, yet remains costly and time consuming. We hypothesize that statistical selection can identify a homogenous group of nonexpert crowdworkers capable of accurately grading inanimate surgical video. DESIGN Applicants auditioned by grading 9 training videos using the Objective Structured Assessment of Technical Skills (OSATS) tool and an error-based checklist. The summed OSATS, summed errors,...
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#1Amr I. Al Abbas (University of Pittsburgh)H-Index: 1
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#1Vernissia Tam (University of Pittsburgh)H-Index: 5
#2Jeffrey Borrebach (University of Pittsburgh)H-Index: 4
Last. Melissa E. Hogg (University of Pittsburgh)H-Index: 17
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Abstract Background While proficiency-based robotic training has been shown to enhance skill acquisition, no studies have shown that training leads to improved outcomes or quality measures. Methods Board-certified general surgeons participated in an optional proficiency-based robotic training curriculum and outcomes from robotic hernia cases were analyzed. Multivariable analysis was performed for operative times to adjust for patient and surgical variables. Results Six out of 16 (38%) surgeons c...
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