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IDENTIFYING CURRICULUM GAP IN FUNDAMENTALS OF ROBOTIC SURGERY AND FUNDAMENTAL SKILLS OF ROBOTIC SURGERY: HANDLING ADVERSE EVENTS

Gunnar Nelson, Nathan Lau, PhD. Virginia Polytechnic Institute & State University

Introduction: The Fundamentals of Robotic Surgery (FRS) and Fundamentals Skills of Robotic Surgery (FSRS) are universal curriculums covering a range of topics to assure a high level of surgical skills for optimal patient outcomes. This assurance of skills should include management and response to adverse events. Thus, we reviewed FRS and FSRS to identify any gaps in educational contents pertaining to how surgical teams are trained to handle adverse events in robotic surgery.

Methods and Procedures: We conducted a literature search through Google Scholar, Journal of Robotic Surgery, and PLOS One on FRS and FSRS from 2010 to 2017. We reviewed 65 articles on  preparing medical professionals in handling adverse events during robotic surgeries. Besides the two curriculums, we also surveyed the literature on the characteristics of the adverse events and responses of the medical team. This literature survey provided a basis for recommending additional education contents to FRS and FSRS.

Results: In our review, the FRS contains 4 modules consisting of an introduction to robotic surgery, with cognitive, psychomotor, and team training/communication skills. Meanwhile, the FSRS contains 16 different tasks, half of which on human-machine interaction and another half on operative interaction. Both curriculums appear to lack contents on managing adverse events in robotic surgery. According to FDA data, 4,798 adverse events were reported per 100,000 surgeries, of which (i) 40% relates to broken pieces of surgical instruments falling into patients, (ii) 19.1% pertains to burning holes in tissue from electric arching, and (iii) 16.9% relates to unexpected operations of the instrument such as power outage and issues with electrosurgical units. Thus, medical professionals should be trained to manage common adverse events in robotic surgery. For FRS, augmenting the five current scenarios in the communication section with common adverse events (i.e., broken pieces falling into patients) would minimize complications under abnormal circumstances. For FSRS, the most logical method would be augmenting the Operative Interaction tasks with adverse events to train medical professionals.

Conclusion: We discovered universal curriculums on robotic surgery lack education contents for training medical professionals to manage adverse events and out of the 4,798  procedures, 4382 (91.3%) pertained to device malfunction. To protect the patient’s health, universal curriculums must incorporate contents preparing medical professionals in responding to adverse events, particularly device malfunctions, during robotic surgeries.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 85271

Program Number: P780

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

107

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