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Mimic Technologies Blog

Tips to Take Your Robotics Program to the Next Level

Here are some tips that may help you take your robotics program to the next level:

• Encourage your robotics committee to establish minimum credentialing thresholds of simulation performance.
• Create accounts for all trainees (i.e., no training under “guest”). This ensures performance can be tracked.
• Implement Mimic curriculum to test for innate ability of residents and fellows. Predict who is most likely to excel in your robotics program.
Ensure training data is regularly uploaded to the cloud with Mimic’s MScore Portal so it can be easily reviewed by your robotics committee. Allow Mimic to customize a dashboard of the data/analytics.
• Use Mimic data analytics to compare your institution’s performance to other hospitals in your IDN or the rest of the world in terms of quality, efficiency, safety, and risk.
Increase access to training by providing simulators outside of the operating room with Mimic’s dV-Trainer (a surgeon console emulator) or FlexVR (a portable simulator that trainees can take home).
Promote team training between the surgeon and the first assist with Mimic’s Xperience Team Trainer. Trainees should prove competence as a first assist before they begin training at the surgeon’s console.
Introduce trainees to procedures with surgeon-lead simulation, Maestro AR (prostatectomy with Drs. Patel & van der Poel, partial nephrectomy with Dr. Gill, hysterectomy with Dr. Advincula, and inguinal hernia with Dr. Low).
Earn CMEs when attending advanced hands-on robotics training programs with MimicMED and MimicMED partners, such as with Florida Hospital Nicholson Center (home of MimicMED), UPMC Center for Advanced Robotics Training (CART), and the STAN Institute at Nancy Hospital (France).

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3 Ways Team Training Can Improve Your Robotics Program

In a recent blog about components of a successful robotic surgery simulation program, team Training was listed as one of the important factors.

‘The study, Teaching Surgical Skills – Changes in the Wind, published in the New England Journal of Medicine by Dr. Richard Reznick, et al., stated, “Virtual reality has the potential to enhance surgical-team training as well as technical skills training. In aviation, teamwork training with simulation has been instrumental in reducing errors. The importance of teamwork in preventing medical error is well recognized, and simulator-based team training has been advocated as a possible preventive approach. Early research results have been promising.”‘

The ability to incorporate team training within a simulation training curricula ensures that the trainees will have well-rounded skills such as communication and movement coordination in addition to being proficient in operating the tool they are training for. So how, specifically, can you improve your robotics program with team training?Mimic4801-XTT-PP-C

Mimic’s Xperience Team Trainer (XTT) is a haptic-enabled laparoscopic trainer that connects to the dV-Trainer, allowing both the first assistant the console surgeon to work together. Currently, the XTT ships with 24 different exercises, of which, 11 are laparoscopic only. These lap-only training exercises allow the first assistant to develop simple skills in areas such as object manipulation, suturing & knot tying, needle control, or in the use of energy and dissection.

The other 11 exercises included are meant to develop skills such as transfers and handoffs, retraction, or clip application and also include a team-training playground environment for those who want to have some fun and practice in a free-form space.

Amongst the available exercises for Mimic’s robotic surgery simulation, Pick and Place is definitely a favorite on the dV-Trainer, the da Vinci© Skills Simulator, and now on the XTT as well. Making this same exercise available on the XTT allows for skills to be tested in a laparoscopic environment as well as in a team mode. Doing the same exercise on both the robotic console and with laparoscopic tools helps to illustrate the differences between the two.

In addition, utilizing simulation training outside of the OR, the XTT allows for:

  1. Better OR Team Communication
    When used together with Mimic’s dV-Trainer, the XTT helps to develop basic skills as it facilitates rehearsal of interaction between the console-side surgeon and the first assist. Learning to work together in both physical movement and verbal communication, in a safe virtual reality environment, helps surgical teams to develop confidence in their ability to work well together. Trainers who have used team training as part of their curriculum have noted that the debrief is often as important as the training exercise itself.
  1. Refinement of Laparoscopic Skills for the First Assistant

In addition to training together with the console-side surgeon, the first assistant can also practice psychomotor skills specific to laparoscopy using the XTT for lap-only exercises. While this is not intended as a standalone laparoscopic trainer, it will help the first assist develop confidence in their ability to work in this environment. It can also be used as a simple way to test an individual’s innate ability.

  1. Learning Port Placement and Training in Multiple Port Positions

Unfortunately, in the real world the first assistant is not always standing comfortably in relation to the patient. Given the position of the patient side cart and the robotic arms, the first assistant is not always in the most ideal position. The XTT can be adjusted to various different port positions that allow the first assistant to practice setting up the laparoscopic instruments to match realistic environments. These Port Placement exercises break down the complicated set up requirements of robotic surgery.

 

Click here to learn more about the XTT. Email info@MimicSimulation.com or call (800) 918-1670 to speak to someone at Mimic to learn more about how to maximize your investment in robotic surgery through simulation training.

 

 

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Why Surgical Skill Should Matter to Hospitals, Surgeons, and Patients

By: Christopher Simmonds

compressed nurseOne of the questions I have often pondered is why do patients choose certain procedures and certain surgeons. So I conducted some research which showed that there were three clear factors that influenced patient choice.

The first was the surgeon they were initially referred to. In the majority of cases, patients will do what their surgeons tells them is the best treatment modality for them. The second most important was family and friends. As soon as you have a diagnosis that will involve a surgical intervention people will talk to their extended network and listen to feedback on similar procedures or interventions.  In today’s connected world it is very easy to connect with a friend of a friend who has faced the same medical challenge.  The last major factor was the internet. While the majority of people will go on the web to browse health care information and to help reinforce decisions made with their healthcare providers, only a small percentage, around 10%, will change their physician and treatment choice based on the internet alone.

This is completely logical as any surgical intervention is really about trust that the surgeon and institution will carry out the procedure and that you will come out the other side as planned. Most people will choose to trust someone once they have met them or rely on the advice of family and friends and are less likely to trust what they have read on the web.

A few years ago I was able to publish a paper that looked at the aspect of patient satisfaction on patients’ willingness to recommend their treatment modality to others.

Hystersisters.com is an online community that was created in 1998 to act as a support group for women to women, dedicated to medical and emotional issues surrounding the hysterectomy experience and gynecologic-related conditions and illnesses, supporting women from diagnosis, to treatment, to recovery.

The research group sent out a questionnaire to the 300,000 members and received over 10,000 responses (however, only 6,263 met the inclusion criteria). We essentially were asking about their perception of their surgical experience and if they would recommend the procedure to someone else in the same position as themselves and, if faced with the same situation would go through the same procedure again.

The table below shows the answers across a variety of modalities and the % who would definitely recommend or choose the same procedure again.

hyster study table

As you can see, there was a significant difference between the types of surgical treatment offered and the willingness to recommend or have the surgery again.

What does this have to with Surgeon skill? I would hope this is obvious. Surgeons who have higher skills and have higher volumes will tend to have better outcomes. We have discussed this fact in earlier blogs.

Better outcomes lead to more satisfied patients who are more likely to recommend the surgeon and institution to family and friends. This will lead to more referrals which will continue as a virtuous circle. The reverse is also true when outcomes are not so positive they can have a negative impact on referrals.

At Mimic, we have always believed that helping surgeons master their tools through simulation is ultimately about helping patients have a better surgical experience and allowing them to get on with their lives as quickly as possible.

 

“The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes”  Published on 17/17/04 in Interactive Journal of Medical Research
Michael C Pitter1*, MDChristopher Simmonds2*Usha Seshadri-Kreaden3*, MS Helen Hubert4*, MPH, PhD 

http://www.i-jmr.org/2014/3/e11/

 

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Mimic’s Maestro AR Prostatectomy Training Curriculum

Maestro_Logo_LG

The gold standard treatment option for men under 70 with early-stage, organ-confined cancer is surgical removal of the prostate using nerve-sparing radical prostatectomy. Since its introduction, surgical robotics has achieved widespread acceptance for performing radical prostatectomies in both the United States and Europe, and is increasing in adoption worldwide. In the U.S., robotic-assisted radical prostatectomy (RARP) is now the most common treatment for localized prostate cancer. Faster operating times, less blood loss, fewer complications, and shorter hospital stays are just a few of the reasons for its popularity among both patients and surgeons.  In the coming years, it is anticipated that relative case volumes for the surgical robots will grow significantly as newer robotic systems are added or replaced in hospitals worldwide.

There is a debate going on currently about the importance of simulated procedural training and the best way to approach it. One approach is to have a complete virtual reality environment where students can “play “at learning the procedure and carry out any task they wish. A second way of learning, which Mimic believes works best is to learn from industry leading surgeons/proctors who can guide students through their own approaches and challenge the learner’s knowledge acquisition. This learning process is then augmented by specific virtual reality tasks that are key parts of the procedure to develop critical psychomotor skills.

There are currently no studies that have been carried out that have been able to validate either approach to procedural training. This is partly due to the recognition that the technology is still not fully advanced enough to simulate the complexity of human tissue and surgical interaction and include all the myriad of potential outcomes as surgeons learn through trial and error.

Clinical societies such as EAU have published guidelines for a structured training program and curriculum for teaching surgeons how to perform a RARP (see European Urology, August 2015, Volume 68, Issue 2, Pages 292–299). Although there is wide acceptance for key steps and strategies for the procedure, differences between cases (e.g. patient considerations, cancer location, desire for neurovascular bundle preservation, need for sentinel lymph node dissection, etc.), differences between robotic platforms (e.g. Xi vs Si), and surgeon preference or experience may warrant some variations in the surgical strategy. For this reason, Mimic has decided to simultaneously release two versions of their Maestro ARTM RARP training curricula. One has been developed based on the da Vinci® Si platform with Dr. Henk Van der Poel (filmed at the Netherlands Cancer Institute, Amsterdam, The Netherlands); the other is based on the da Vinci® Xi platform with Dr. Vip Patel (filmed at Florida Hospital, Orlando, FL, USA).

Both procedures offer a complete training solution for RARP, from initial patient and robot setup, to the final urethrovesical anastomosis. Each Maestro ARTM training curriculum integrates high definition 3D video footage from an actual RARP (narrated by the surgeon who performed the case) with augmented reality interactive tasks such as recognition of key anatomical structures, identification of surgical planes and landmarks, energy application, tissue retraction, and multiple choice questions. Additionally, each Maestro curriculum includes a set of virtual reality exercises selected by the surgeon and designed to teach specific robotic skills that are important at the various stages of the procedure.

The table below highlights the variation between the two curricula:

blog table

Although the major steps of the procedures are the same, the Si and Xi versions of the Mimic Maestro ARTM RARP curricula are differentiated at several key moments. These include: the location and technique for the initial peritoneal dissection and entry into the Space of Retzius, the timing and suturing technique used to ligate the Dorsal Venous Complex, the approach for the dissection of the posterior bladder neck and seminal vesicles, the strategy used during the preservation of the neurovascular bundle, and the type of suture and technique for the posterior reconstruction (Rocco stitch) and urethrovesical anastomosis.

Additionally, the Xi module highlights a new feature giving the surgeon the ability to rotate a 30 degree endoscope from a 30-down view to a 30-up view with the push of a button in order to gain greater visualization beneath the prostate during posterior dissection. Ultimately, the different styles, teaching preferences, and words of wisdom from our two surgeon collaborators offer a complete and well-rounded training pathway for any surgeon wanting to learn best practices for RARP on either robotic platform.

 

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