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Surgical Robots Complicate Training Of New Residents: Study

A new report warns that the use of surgical robots, such as the da Vinci robot medical system, is making the training of new medical residents more complicated, because they have to be taken off of the machine when they make an error. 

Usually, when a resident makes a mistake during a surgical procedure, they are allowed to continue to have hands-on participation while the doctor overseeing them shows them their error. However, according to a new report published in Administrative Science Quarterly on January 9, the design of robot surgery systems requires that the doctor completely take over the procedure, leaving residents at the side lines and potentially missing valuable experience.

The report, by Dr. Matthew Beane, of the University of California Santa Barbara, warns that medical residents, as well as trainees in all types of industries that are becoming more and more automated, are going into their professions with less hands-on training than previous generations. That is because the design of automated systems, including medical robots, allows for less participation.

His report drew data from two studies, including a multi-sited ethnography and an interview-based study. The ethnography took place over two years at five teaching hospitals in the northeastern U.S. The interview study involved urological surgeons and medical residents at 13 top-tier teaching institutions nationwide.

The studies looked at both open surgical methodologies and robotic surgeries performed with the da Vinci, and their effects on surgical trainees. According to the findings, while some residents were able to develop a high level of skill with the da Vinci, many did not, due to the lack of “dwell time”, meaning time actually training on the device.

“One of the main reasons APs (attending physicians) relied on residents to perform open surgery is that these residents had several years of embodied practice with basic techniques such as establishing and maintaining a sterile field, suturing, retracting, and making incisions, and could therefore perform these fluidly under pressure,” Beane wrote. “But most residents practiced robotic surgical technique a few hours a year, at best, and they were far less fluent with basic robotic technique.”

The report indicates that standard robotic surgical techniques have made it “practically impossible” for residents to learn how to use the da Vinci through peripheral participation. At best, he said, all residents got to do was place the patient onto the surgical bed before the attending physician arrived and had to do nearly everything else, such as positioning, marking surgical sites, making incisions and attaching the robot.

“All this meant the practical elimination of the AP-free portions of a procedure,” he determined. “For the resident, this meant a dramatic reduction in opportunities to ‘do’ parts of the procedure without significant supervision and a near elimination of opportunities to ‘teach’ other more junior residents.”

Beane said that the issues represent a significant threat to residents acquiring robotic surgical skill, which were compounded by how attending physicians methods of supervising and teaching the residents how to use the devices.

The study indicates that residents using a surgical robot had 10 to 20 times less time doing surgical tasks during robotic procedures than they had during surgical tasks during open surgical procedures.

“In open [surgery], if you put a hole in the iliac vein, yeah, it’s a big problem, but you can put your finger there, compose yourself and get control. If you cause that in a robotic procedure, the patient could hemorrhage before you regain visualization,” one resident interviewee said. “If they [surgeons] think they can do it by themselves safely, they’re not going to want to take that risk.”

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