Robotic Microsurgery in Male Infertility and Urology

Taking Robotics to the Next Level

Ahmet Gudeloglu; Jamin V. Brahmbhatt; Sijo J. Parekattil


Transl Androl Urol. 2014;3(1):102-112. 

In This Article

Robotic Microsurgery Training

In standard microsurgery, it has been well established that training in a microsurgery laboratory improves the surgeon's confidence, reduces stress and reduces the operating duration.[23] Similarly, it is likely that training on a robotics platform will likely lead to similar benefits for robotic microsurgery.

A classification of robotic microsurgical training models and examples for each model are summarized in Table 2.[53] Initially simulators and practicing with non-living non-biologic materials are recommended to become familiar with the robotic system.[53]

Our group performed a study recently to assess how skills may be acquired for robotic microsurgery using non-traditional approaches.[54] In this study, one group of robot naïve participants trained for robotic microsurgery by building Lego® structures with the robot using all three arms. This group was compared to another similar group that trained by practicing repetitive robotic microsurgical anastomosis on a synthetic vas deferens (Syndaver®) model. When these two groups were tested before and after the training sessions (by performing an anastomosis on the synthetic vas), both groups demonstrated a significant similar improvement in their robot skills. This opens up a whole avenue of potential exercises and tasks that may help improve a microsurgeon's robotic skills indirectly.

A progression on to non-living biological models is then recommended such as vas deferens segments from major radical cystectomy specimens.[53] Ruggiero has also shown the feasibility of using earthworms for robotic microsurgery training.[55] Finally, performing robotic microsurgical vascular anastomosis on living models such as rat and rabbit are recommended.[53]

Whether one can transfer previous microsurgery skills to robotic microsurgery is another concern in training. Karamanoukian et al. conducted a study[56] where they compared microsurgical vascular anastomosis of fully trained vascular surgeons and mid-level surgical residents on the robotic system. They found no significant difference between the groups and so previous microsurgical experience did not seem to affect the learning curves on the robot. Ramdhian et al. compared learning curves of robotic anastomosis and standard microsurgical anastomosis on a robot and microsurgical naïve surgeon.[57] Although the learning curve for standard microsurgical anastomosis was faster than for robotic anastomosis, the difference was not statistically significant.[57]

One additional area of importance for robotic assisted procedures is the training and experience of the operating room staff. Since robotic procedures entail a team effort, training of all team members including the anesthesiologist, circulator, scrub nurse and surgical assistant are crucial for the effective performance of the team.[58]