Browsing by Author "Satava, Richard M."

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Demonstrating the effectiveness of the fundamentals of robotic surgery (FRS) curriculum on the RobotiX Mentor Virtual Reality Simulation Platform
    (Springer, 2021-04) Martin, John Rhodes; Stefanidis, Dimitrios; Dorin, Ryan P.; Goh, Alvin C.; Satava, Richard M.; Levy, Jeffrey S.; Surgery, School of Medicine
    Fundamentals of robotic surgery (FRS) is a proficiency-based progression curriculum developed by robotic surgery experts from multiple specialty areas to address gaps in existing robotic surgery training curricula. The RobotiX Mentor is a virtual reality training platform for robotic surgery. Our aims were to determine if robotic surgery novices would demonstrate improved technical skills after completing FRS training on the RobotiX Mentor, and to compare the effectiveness of FRS across training platforms. An observational, pre-post design, multi-institutional rater-blinded trial was conducted at two American College of Surgeons Accredited Education Institutes-certified simulation centers. Robotic surgery novices (n = 20) were enrolled and trained to expert-derived benchmarks using FRS on the RobotiX Mentor. Participants’ baseline skill was assessed before (pre-test) and after (post-test) training on an avian tissue model. Tests were video recorded and graded by blinded raters using the Global Evaluative Assessment of Robotic Skills (GEARS) and a 32-criteria psychomotor checklist. Post hoc comparisons were conducted against previously published comparator groups. On paired-samples T tests, participants demonstrated improved performance across all GEARS domains (p < 0.001 to p = 0.01) and for time (p < 0.001) and errors (p = 0.003) as measured by psychometric checklist. By ANOVA, improvement in novices’ skill after FRS training on the RobotiX Mentor was not inferior to improvement reported after FRS training on previously published platforms. Completion of FRS on the RobotiX Mentor resulted in improved robotic surgery skills among novices, proving effectiveness of training. These data provide additional validity evidence for FRS and support use of the RobotiX Mentor for robotic surgery skill acquisition.
  • Thumbnail Image
    Item
    Expert Consensus Recommendations for Robotic Surgery Credentialing
    (Wolters Kluwer, 2020-11) Stefanidis, Dimitrios; Huffman, Elizabeth M.; Collins, Justin W.; Martino, Martin A.; Satava, Richard M.; Levy, Jeffrey S.; Surgery, School of Medicine
    Objective: To define criteria for robotic credentialing using expert consensus. Background: A recent review of institutional robotic credentialing policies identified significant variability and determined current policies are largely inadequate to ensure surgeon proficiency and may threaten patient safety. Methods: 28 national robotic surgery experts were invited to participate in a consensus conference. After review of available institutional policies and discussion, the group developed a 91 proposed criteria. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed criteria in three electronic survey rounds after the conference. Criteria that achieved 80% or more in agreement (consensus) in all rounds were included in the final list. Results: All experts agreed that there is a need for standardized robotic surgery credentialing criteria across institutions that promote surgeon proficiency. 49 items reached consensus in the first round, 19 in the second, and 8 in the third for a total of 76 final items. Experts agreed that privileges should be granted based on video review of surgical performance and attainment of clearly defined objective proficiency benchmarks. Parameters for ongoing outcome monitoring were determined and recommendations for technical skills training, proctoring, and performance assessment were defined. Conclusions: Using a systematic approach, detailed credentialing criteria for robotic surgery were defined. Implementation of these criteria uniformly across institutions will promote proficiency of robotic surgeons and has the potential to positively impact patient outcomes.
  • Thumbnail Image
    Item
    Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial
    (Lippincott, 2020-08) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of Medicine
    Objective: To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. Summary Background Data: There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. Methods: Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. Results: All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82–0.97) but moderate for GEARS ratings (0.40–0.67). Conclusions: We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.
  • Thumbnail Image
    Item
    Response to “Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial” Not only surgeon's manual skills...”
    (Wolters Kluwer, 2020-12) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of Medicine
  • Thumbnail Image
    Item
    Utilising an Accelerated Delphi Process to Develop Guidance and Protocols for Telepresence Applications in Remote Robotic Surgery Training
    (Elsevier, 2020-12) Collins, Justin W.; Ghazi, Ahmed; Stoyanov, Danail; Hung, Andrew; Coleman, Mark; Cecil, Tom; Ericsson, Anders; Anvari, Mehran; Wang, Yulun; Beaulieu, Yanick; Haram, Nadine; Sridhar, Ashwin; Marescaux, Jacques; Diana, Michele; Marcus, Hani J.; Levy, Jeffrey; Dasgupta, Prokar; Stefanidis, Dimitrios; Martino, Martin; Feins, Richard; Patel, Vipul; Slack, Mark; Satava, Richard M.; Kelly, John D.; Surgery, School of Medicine
    Context The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. Objective To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standardised approach to training candidates in skill acquisition via telepresence technologies. We aim to describe an approach based on the current evidence and available technologies, and define the key elements within optimised telepresence services, by seeking consensus from an expert committee comprising key opinion leaders in training. Evidence acquisition This project was carried out in phases: a systematic review of the current literature, a teleconference meeting, and then an initial survey were conducted based on the current evidence and expert opinion, and sent to the committee. Twenty-four experts in training, including clinicians, academics, and industry, contributed to the Delphi process. An accelerated Delphi process underwent three rounds and was completed within 72 h. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement. Evidence synthesis There was 100% consensus regarding an urgent need for international agreement on guidance for optimised telepresence. Consensus was reached in multiple areas, including (1) infrastructure and functionality; (2) definitions and terminology; (3) protocols for training, communication, and safety issues; and (4) accountability including ethical and legal issues. The resulting formulated guidance showed good internal consistency among experts, with a Cronbach alpha of 0.90. Conclusions Using the Delphi methodology, we achieved international consensus among experts for development and content validation of optimised telepresence services for robotic surgery training. This guidance lays the foundation for launching telepresence services in robotic surgery. This guidance will require further validation.