Robotic-assisted laparoscopic gynecologic procedures in a fellowship training program.
OBJECTIVE
The robotic surgical platform is an alternative technique to traditional laparoscopy and requires the development of new surgical skills for both the experienced surgeon and trainee. Our goal was to perform an early evaluation of the feasibility of training fellows in robotic-assisted gynecologic procedures at the outset of our incorporation of this technology into clinical practice.


METHODS
A systematic approach to fellow training included (1) didactic and hands-on training with the robotic system, (2) instructional videos, (3) assistance at the operating table, and (4) performance of segments of gynecologic procedures in tandem with the attending physician. Time to complete the entire procedure, individual segments, rate of conversion to laparotomy, and complications were recorded.


RESULTS
Twenty-one robotic-assisted gynecologic procedures were performed from April 2006 to January 2007. Fellows participated as the console surgeon in 14/21 cases. Thirteen patients (62%) had prior abdominal surgery. Median values with ranges were age 51 years (range, 33 to 90); BMI 28 (range, 19.4 to 43.8); EBL 25 mL (range, 25 to 250); and hospital stay 1 day (range, 1 to 4). No significant difference existed between fellow and attending mean total operative and individual segment times. One conversion to laparotomy was necessary. No major surgical complications occurred.


CONCLUSIONS
These data suggest that it is feasible to incorporate a systematic approach to robotic-assisted laparoscopic training for trainees at the outset of incorporation of this technology into current practice.
Lee
Paula S
PS
Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. paula.s.lee@duke.edu
Bland
Amy
A
Valea
Fidel A
FA
Havrilesky
Laura J
LJ
Berchuck
Andrew
A
Secord
Angeles Alvarez
AA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012371:Robotics / Q000193:education* / Q000379:methods; D016896:Treatment Outcome