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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
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The Assist
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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
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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
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Multi-modal training
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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
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Da Vinci Competency Checklist
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https://www.davincisurgerycommunity.com-Training tab-dV Technology Training Pathways-First Assist Form
NYU Competency Checklist
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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
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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
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Live Case Observation
• Observing case from setup to case finish; Double scrub
with experienced assist. (# varies)
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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.
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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”
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Putting things all together
The learning curve can be challenging and stressful
but remember patience and most importantly
practice, practice, PRACTICE.
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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
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