Robotic GYN Curriculum

Below is the detailed Robotic GYN Curriculum Education under the direction of Dr. Munther Alaiwat.

Objectives

  • Understanding and correctly identifying the various components of the da Vinci Si robotic platform
  • Mastering the safe and efficient set up of the patient in the operating room
  • Developing laparoscopic skills as a first assistant
  • Docking and troubleshooting the robotic platform during the surgical procedure
  • Developing adequate surgical skills as the primary surgeon to qualify for a "Certificate of Robotic Surgical Training", which would allow our graduating residents to start practicing robotics without the need to be proctored
  • Maintaining current knowledge of robotic literature in our specialty
  • Providing a system that helps guide Attending expectations regarding knowledge/skill level of the residents at various stages of their training

PGY-1

  1. On-Line Modules & Assessments
    • daVinci Si System Overview
    • OR Setup and System Connections
    • Vision System
    • Draping
    • Docking
    • Safety Features
    • da Vinci Si OR Staff Assessment
    • EndoWrist SmartPedal Technology Upgrade:
    • SmartPedal Technology Overview
    • SmartPedal Technology In-Service
    • Smart Pedal Assessment
    *Minimum score of 80% required on simulator
  2. One completed Hands-on da Vinci Si Surgical System Overview (dry lab)* -. Time commitment: (2 hours per da Vinci System, 2 offered yearly)
  3. Procedure Observation:- 2 live cases, 2 remote cases
  4. Literature Review: Past/Current Publications –1 two hour lecture/year. 2 offered yearly
  5. Six bedside first assist cases/year

PGY-2

  1. On-Line Modules & Assessments
    • da Vinci Si System Overview
    • OR Setup and System Connections
    • Vision System
    • Draping
    • Docking
    • Safety Features
    • da Vinci Si OR Staff Assessment
    • EndoWrist SmartPedal Technology Upgrade:
    • SmartPedal Technology Overview
    • SmartPedal Technology In-Service
    • Smart Pedal Assessment
    *Minimum score of 80% required on simulator
  2. One completed Hands-on da Vinci Si Surgical System Overview (dry lab)* -. Time commitment: (2 hours per da Vinci System, 2 offered yearly)
  3. Procedure Observation : 3 cases (1 of these should be a GYN Oncology case)
  4. Literature Review: Past/Current Publications –1 two hour lecture. 2 offered yearly
  5. 10 bedside first assist cases/year (as PGY-2s, 3 of these 10 cases need to be done with Dr. Alaiwat)

PGY-3

  1. Literature Review: Past/Current Publications –1 two hour lecture/year. 2 offered yearly
  2. 10 second console assist (<50% of case) cases/year
  3. 1 completed Hands-on da Vinci Si Surgical System Overview (dry lab)* -. Time commitment: (2 hours per da Vinci System, 2 offered yearly)
  4. Having met all above criteria, start collecting cases as primary surgeon for robotic hysterectomy in the absence of PGY-4

PGY-4

  1. Literature Review: Past/Current Publications –1 two hour lecture/year. 2 offered yearly
  2. Collect a minimum of 20 cases as primary surgeon for robotic hysterectomy
  3. Teach da Vinci dry lab*with Dr. Alaiwat, 2 per year

*Dry Lab Appendix

The Dry Lab:

In this exercise, the instructor and the residents will be introduced to the appropriate terminology for each component of the robotic platform, in addition to the role of each component and the correct terminology of communicating troubleshooting various issues that occur during any surgical procedure.

The resident is introduced to the following components with emphasis on using the correct terminology:

  1. Vision Cart
  2. Surgeon Console
    • View port
    • Master controls
    • Headrest
    • Stereo viewer
    • Left and right side pods house the user interface controls
    • Touch pad for audio, video and settings control
    • Arm rest
    • Footswitch panel
    • Side handles (used for moving the surgeon console)
  3. Patient Cart
    • Throttle (switch and rotation to move the cart)
    • The Drive (D) and Neutral (N) positions
    • Camera arm
      • Camera arm set up joints
      • Camera arm clutch button
      • Camera arm port clutch
      • Camera arm cannula mount
      • Camera arm mount molding
    • Instrument arm
      • Instrument arm set up joints
      • Instrument arm clutch button
      • Instrument arm port clutch button
      • Instrument arm cannula mount
      • Instrument arm cannula mount molding
    • Instrument arm LED’s
      • Solid white: Not ready for surgeon console control
      • Alternate side-to-side blinking green and white: Guided tool change
      • Alternate side-to-side blinking white: Clutching
      • Bright blue: Ready for surgeon console control
      • Yellow: Intervention required
      • Red: System fault
      • Fast blinking green: System start up and new instrument line information downloading
  4. Basic Port Placement
    • Maintain the Sweet spot
    • Place the camera port so it aligns with the center column of the patient cart and the target anatomy
    • Use the 20-10-5 rule as follows:
      • Place the camera port about 10-20 cm away from the target organ
      • Maintain at least 8-10 cm spacing between the da Vinci ports
      • The instruments should be 10-20 cm away from the target anatomy
      • Accessory ports should be at least 5 cm away from the other ports
  5. Docking
    • Ensure camera arm elbow and “Sweet Spot” are set and instrument arms are in position to maximize range of motion and minimize collisions
    • Align the endoscope port with the target anatomy and with the Patient Cart’s center column
    • With arms positioned high enough to clear the patient, drive the Patient Cart in, maintaining the “Sweet Spot” and alignment with endoscopy ? 3rd elbow ? Patient Cart’s center column
    • Position the cart using two people: one to drive the cart and one to direct cart movement
    • Stop the Patient Cart when the camera cannula mount is in position over the camera port cannula incision
    • Dock the camera arm using the port clutch buttons, making sure that both of the quick click cannula mount wings are closed
    • Insert the endoscope into the cannula and assess the surgical site
    • Dock the instrument arms using the port clutch buttons, making sure that both of the quick cannula mount wings are closed
    • Note: If the System is in Drive (D), as soon as any cannula is attached to an arm, the Patient Cart motor drive brakes automatically engage
  6. Surgeon Console Overview
    • Right Side Pod
      • Power button
      • Emergency stop
    • Touchpad: Contains video, audio, utilities and surgeon log in tabs
    • Left Side Pod: Ergonomic controls for the stereo viewer height and tilt controls, arm rest height, foot switch panel depth (the distance between the foot switch panel and the chair)
    • Stereo viewer
    • Foot switch panel:
      • Surgeon Console brakes: Both should be engaged during procedure
      • Arm swap pedal: A quick side tap of the pedal allows the master controllers to switch control to a different instrument arm
      • Camera control pedal: Pressing and holding the pedal allows the masters to control movement of the camera and endoscope
      • Master clutch pedal: Pressing and holding the pedal decouples the master controllers from instrument control, and allows the surgeon to reposition the masters for ergonomic comfort
      • Energy control: Two sets or primary (blue) and secondary (yellow) pedals provide expanded control of energy devices allowing surgeons to use instruments with more than one energy modality (e.g. For monopolar instruments CUT is enabled in addition to COAG)
    • Always take a look in the stereo viewer and verify foot location on the foot switch panel before activating the energy pedals
  7. Master Controls
    • Repositioning the masters by either using the foot or finger clutches
    • Match Grips
      • When a new instrument is inserted, the match grips icons will appear
      • The match grip icons will indicate the action needed to match master grip angle to the instrument grip angle (open or close masters, or slightly rotate the grips on the masters)
    • Repositioning camera
      • Press and hold the camera control pedal
      • Move the masters to reposition the image
    • Focusing the camera: Press and hold the camera control pedal, then roll a single master to focus the image (NOTE: Camera focus can be controlled independently by either/or both master controllers, as long as one of both of the masters moves enough to indicate an intentional movement by the user.)