Robotic Fellowship Training in the UK

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SURG / TUF session on Robotic Fellowship Training in the UK

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  • Robotic technology has been adopted rapidly over the past 5 years in both the United States and Europe. The number of robot-assisted procedures that are performed worldwide has nearly tripled since 2007, from 80,000 to 205,000. Between 2007 and 2009, the number of da Vinci systems, that were installed in U.S. hospitals grew by approximately 75%, from almost 800 to around 1400, and the number that were installed in other countries doubled, from 200 to nearly 400, according to Intuitive Surgical,
  • Robotic Fellowship Training in the UK

    1. 1. Mr N VasdevPost CCT Robotic Urology Fellow(Royal College of Surgeons of England / BAUS National Accredited Fellowship Programme)Lister HospitalStevenageFaculty in Robotic UrologyChitra Sethia Robotic CentreUCLHLondonROBOTIC FELLOWSHIP TRAINING IN THE UK
    2. 2. INTRODUCTION• The widespread adoption of robotic technology over the past decade hasresulted in significant changes in the way numerous urological conditions aremanaged• Robotic devices continue to evolve and as they become less expensive andmore widely disseminated – it is likely they will become more frequentlyutilized in an increasing number of surgical procedures• The rapid introduction of robotic procedures in urology necessitates the needfor the development of new training methods
    3. 3. 19992000200120022003DA VINCI® EUROPEAN INSTALLED SYSTEMS 1999 – 20122004200520062007200820092010-12
    4. 4. WHAT’S CHANGED IN THE LAST DECADE?Healthcare Cost and Utilization Project, Nationwide Inpatient Sample 2000–2008. NEJM,, 2010ANNUAL NUMBER OF RADICAL PROSTATECTOMIES CARRIED OUT IN ENGLAND , 1997- 2010(SOURCE: HES DATA)
    5. 5. TRAINING METHODS IN ROBOTIC UROLOGICALTRAINING• Robotic Simulation Training• Simulation and Teaching enhanced learning initiative (STeLi) – Prof Dasgupta/Mr S Khan• Robotic Fellowship Training• Structured Training programme that is competence/ assessment based• There is no validated or standardized curriculum currently in existence fortraining in basic robotic surgical skills at present within the UK• In a worldwide survey of both practising and trainee urologists, 78% ofrespondents felt it was required or beneficial to have training in RS 22. Guru KA et al, Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 2009;16:4736–41
    6. 6. ROBOTIC FELLOWSHIP TRAINING IN THE UK• There are currently 32 robotic systems installed in UK and Ireland, but thegeographical and population density localization is uneven. Most are locatedin London and the South East• Only 6 (18.7%) of these centers offer robotic fellowship training currently[Only 1 fellowship Programme is currently recognized by the RCS/BAUS]• Increased demand has led many practicing urologists to seek robotic training• Furthermore, as robotic programs are newly introduced into urologic teachingcenters, current SpR’s often do not get adequate robotic training while manyin the faculty including robotic fellows are still overcoming their own learningcurves
    7. 7. WHO APPLY KEEN TO APPLY FOR ROBOTICFELLOWSHIP TRAINING IN THE UKUKRoboticFellowshipTrainingUK TraineesVisiting FellowsOverseas Trainees(Europe / Australia)
    8. 8. ROBOTIC FELLOWSHIP TRAINING IN THE UK• There are 3 essential components to a robotic structured teaching program• Maximizing the quality of robotic surgical training and minimizing adversepatient outcomes is best achieved through a structured mentoring/ fellowshipprogrammeRoboticFellowshipTrainingPreclinicalPhaseTable sideassistantphaseOperativeconsolephase
    9. 9. ROBOTIC FELLOWSHIP TRAINING IN UK• In a robotic fellowship care must be provided in the context of a close-knitsurgical team• There is no substitute for a regulated training fellowship programme.‘Learning by doing’ is simply not good enough and puts the patient at risk 3• Methodologies to improve robotic on-table surgical training include• Dual Console training• Strict audit• Video feedback• Debrief3. Patel VR,, et al. Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol. 2005
    10. 10. CURRENT CENTERS OFFERING ROBOTICFELLOWSHIPS IN THE UK• 1. Lister Hospital , Stevenage *• 2. UCLH, London [Including the Chitra Sethia Robotic Training Centre]• 3. Guys Hospital, London• 4. Royal Marsden Hospital, London• 5. Addenbrooke’s Hospital, Cambridge• 6. Bristol Urological Institute*RCS/BAUS national accredited fellowship programme 44. http://accreditation.rcseng.ac.uk/Home/InfoAccreditedFellowship
    11. 11. SUPPORT AVAILABLE FOR ROBOTICFELLOWSHIP TRAINING IN THE UK• The Urology Foundation (TUF) funds a number of national and internationalrobotic preceptorships in collaboration with Kings College London to supportthe safe training of individual surgeons and their teams• Support from TUF is provided via clinical visits and Robotic Assisted SurgeryProgramme• Intuitive Surgical Educational Grants• Clinical Robotic Research Grants• Technology Research Grants• Clinical Robotic Fellowship
    12. 12. ROBOTIC FELLOWSHIP TRAINING – MYEXPERIENCE (LISTER ROBOTIC FELLOWSHIP)• Completed my CCT in September 2012 (Northern Deanery)• 110 hours of dry lab training• 9 months into my fellowship• 115 Robotic Cases• Robotic Prostatectomy = 84 (15 independent cases)• Robotic Partial Nephrectomy = 11• Robotic Cystectomy = 9 (3 intracorporeal conduit + 2 neobladders)• Robotic Nephrectomy = 4• Robotic Pyeloplasty = 7 (3 independent cases)
    13. 13. ROBOTIC FELLOWSHIP TRAINING – MYEXPERIENCE (LISTER ROBOTIC FELLOWSHIP)No effect on patient safety and oncological outcome with the introduction of therobotic fellowship programme
    14. 14. CONCLUSION• As the application of robotic surgery continues to expand in urologic surgeryin the UK, the need to train proficient robotic surgeons will also increases• Robotic fellowship training exists in many current forms and is currentlywithout standardization in the UK• The most effective robotic training approach appears to be a structuredfellowship training programme• As technology continues to advance, surgical simulation is likely to play anessential role in the training of future robotic urologist to improve mastery ofrobotic surgical skills
    15. 15. ACKNOWLEDGEMENT• Mr James Adshead , Consultant Robotic Surgeon, Lister Hospital• Mr Gregory Boustead, Consultant Robotic Surgeon, Lister Hospital• Mr Tim Lane, Consultant Robotic Surgeon, Lister Hospital• Dr Gowrie Mohan, Consultant Anesthetist, Lister Hospital• Mrs June Thomas, Robotic Coordinator/ Sister Theatre, Lister Hospital• Chitra Sethia Robotic Centre, UCLH

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