HOW TO SHORTEN THE LEARNING CURVE IN THE … · coordinator from the facility. oPatient positioning...

HOW TO SHORTEN THE

LEARNING CURVE IN THE OR

Adaeze Mogbo MPAS, PA-CRobotics Physician Assistant Baylor Scott and White-Plano

NARUS

February 16, 2018

Financial disclosures:

None

1

The Assist

2

A well-trained bedside assistant is just as important as the console surgeon.

Assist experience

• New Grad Assist• Little OR experience from rotations to none

• Unfamiliar with laparoscopic procedures/assisting

• At least 1 year OR experience• Some laparoscopic experience

• Some Assist experience

• Experienced Assist • More Laparoscopic exposure

• More assist experience

3

4

0

2

4

6

8

10

12

0-10-cases 10-20 cases 20-30- cases 30-40+cases

Robotic Assist Learning Curve

New Grad 1>year exp Experienced assist (+4 years)

Robotic Assist Learning Curve

Factors affecting the curve include

o Volume/Repetition

o Complexity of cases

o Prior surgical experience

o Consistent team

o Surgeon familiarity

5

Multi-modal training

6

Knowledge (didactic) Skills lab (Hands-on)

Videos/Prep work Live case observation/Proctoring

Knowledge (Didactic)

• daVinci Competency checklist or Institution

created Robotic competency pathway.

• Online training First assist modules from the

daVinci Community website

o Certificate of Completion

7

Da Vinci Competency Checklist

8

https://www.davincisurgerycommunity.com-Training tab-dV Technology Training Pathways-First Assist Form

NYU Competency Checklist

9

Skills Lab (Hands-On)

• “Dry Labs”: On site training given by Intuitive

representative and in some cases the robot

coordinator from the facility.

o Patient positioning

o Robot positioning

o Port positioning

o Docking proficiency

o Insertion/Exchange instrumentation

o Troubleshooting scenarios

o Fault management

10

Videos/Prep Work

• The first phases of tackling learning curve gap is

understanding the anatomical relations and memorizing

the steps of the operation.

• Watching videos of the procedure YouTube or da Vinci

Online Community

11

Live Case Observation

• Observing case from setup to case finish; Double scrub

with experienced assist. (# varies)

12

Proctoring

• After observation transition to proctored cases

with experienced assist. (~5-10) can vary

depending on comfort level

• Then it is time to FLY solo.

13

Additional pointers

• Set-up additional dry lab practice with Intuitive representative/experienced assist

• After each case debrief with surgeon and proctor.

• If working with one or multiple surgeons, have a personal “surgeon preference card”

o Notes to anticipate next steps in case

o Special instrument requests, positioning, etc.

o “What worked and what didn’t”

14

Putting things all together

The learning curve can be challenging and stressful

but remember patience and most importantly

practice, practice, PRACTICE.

15

16

Purpose: We designed a three-phase bedside assistant training course for those involved with robot-assisted radical prostatectomy (RARP). We also examined whether an experienced RARP team (>1000 cases) would perceive benefit from this three-phase bedside assistant training course.

Conclusions: A three-phase hands-on RARP bedside assistant training course is beneficial to and desired by an experienced RARP team at least annually.

Sources

Images: Google.com

daVinci Community website

17