Ballas Derek, Cesta Megan, Roulette G Dante, Rusnak Margaret, Ahmed Rami
Department of Obstetrics & Gynecology, Summa Health; Department of Medical Education, Summa Health;
Department of Obstetrics & Gynecology, Summa Health.
J Vis Exp. 2018 May 20(135):57286. doi: 10.3791/57286.
The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.
以下是一个培训平台，旨在让机器人外科医生培养在紧急情况下拆卸机器人系统时领导跨专业团队所需的技能。在传统的外科医生机器人培训中，在机器人系统的初始入门培训期间，会提供基于网络的简短紧急拆卸概述。在此过程中，没有针对手术室（OR）人员跨学科角色的培训。这里介绍的培训采用形成性模拟和汇报，随后进行讲座。对于模拟，一个改良的妇科模拟器被放置在与大多数妇科腹腔镜手术一致的陡峭头低脚高位。使用连接到装有红色食用色素静脉输液压力袋的管道对训练躯干进行改良，以便根据需要模拟灾难性血管损伤。在整个手术室环境中安排了一个跨专业团队，由嵌入式标准化人员（ESP）组成，以履行巡回护士、洗手护士、麻醉师和床边辅助外科医生的角色。向机器人外科医生呈现一个需要紧急拆卸的病例场景，并让他们控制机器人器械。该场景在成功完成紧急拆卸后终止，或者由于病例的紧急性质在五分钟后终止。模拟之后是一个汇报环节，对手进行紧急拆卸步骤、必要设备、故障排除技术和手术室人员角色的培训。为学习者提供一个简短的讲座，再次强调汇报中呈现的材料，供他们自学。这种培训可缩短接触患者的时间，提高知识、信心和关键操作的完成情况，并且可以在大多数机构中复制。所有机器人外科医生都应该能够证明自己在这一关键干预方面的能力。该课程的一个局限性是无法为培训目的获取现场环境。
