Training Better Robotic Surgeons
LULU GARCIA-NAVARRO, HOST:
When you go into your next surgery, your doctor may have some help from robots - yes, robots. Institutions across the U.S. have rapidly adopted this technology. But one very big problem - many doctors don't know how to use them. Mary Scott Hodgin of member station WBHM reports.
MARY SCOTT HODGIN, BYLINE: Robot-assisted surgery is minimally invasive, and recovery time is often shorter. Those are a few reasons patients and doctors like it. But the technology is expensive. And studies show it can sometimes lead to worse long-term outcomes than other types of surgery. Still, the device has become common practice in some specialties, which means more surgeons are learning to use it.
KENNETH KIM: It's not necessarily, is robot better? Robot is just another tool that they need to master just like any other surgical tool.
SCOTT HODGIN: That's Dr. Kenneth Kim. He directs the robotic training program at UAB Hospital in Birmingham, Ala. Kim says the first step to learning robotic surgery is understanding how to use the robot. But that's not easy.
KIM: It never was an issue because open surgery, like scissors - like, everyone learns how to use scissors in kindergarten. Everyone knows, functionally, how to use a knife. But with the robot, it's a totally different, new tool, and it's more complex. So now that has a separate learning curve.
SCOTT HODGIN: To be clear, the robot isn't self-operating, at least not yet. The way it works is the surgeon sits at a console, sort of like a big video game, and uses hand and feet controls to manipulate a separate surgical part attached to the patient. Kim says one way students get comfortable with the device is virtual reality.
KIM: Having trouble?
THERESA BOITANO: That one's always the trouble one, especially if they're small.
SCOTT HODGIN: Surgical residents gather with Kim at UAB Hospital. They're practicing on a new robotic simulator. Theresa Boitano is an OB-GYN resident at UAB. She's maneuvering the robotic arms with precision to lift colorful rings and place them onto spikes, almost like a kid's game.
BOITANO: And so I'm going now to grab this first ring. And at the same time, I'm thinking, OK. Now where do I need to go to the next one? You're always trying to stay ahead of the game but then also making sure you're not doing any errors at the same time.
SCOTT HODGIN: The simulator records everything - how accurately she moves the robot arms, how fast she completes the exercise. It provides objective data about how well a surgeon performs. Dr. Khurshid Guru says this helps standardize the training process. Guru directs robotic surgery at Roswell Park Comprehensive Cancer Center in New York.
KHURSHID GURU: The analogy is that now you don't have to worry about learning how to drive a car because everybody could get one on the street. They are taught the basic principles of driving a car. The million-dollar question now is, when would you allow them to get onto the expressway?
SCOTT HODGIN: Guru says that's the next step - when surgeons specialize in different procedures. Dr. Monica Hagan Vetter of Ohio State University has studied robotic training programs across the country. She says using a simulator to measure surgical ability helps ensure surgeons have a certain level of skill before they actually operate on people.
MONICA HAGAN VETTER: You can learn the steps of the procedure. But if you don't know how the robot works, if you don't know how to troubleshoot the robot or what to do in an emergency, then even if you can perform the world's best hysterectomy and you know all the steps and all the instruments, you are not safe to do that.
SCOTT HODGIN: Dr. Kenneth Kim says simulators and the data they provide are great for that first step - learning to use the robot as a tool. But he says surgeons still have to watch and learn.
KIM: The simulator's good, but it can only simulate so much.
SCOTT HODGIN: In the real world, Kim says robot-assisted surgery isn't right for every patient. A surgeon needs to know when to use it and when not to. And those decisions can change as researchers continue to study patient outcomes from robotic surgery.
For NPR News, I'm Mary Scott Hodgin in Birmingham.
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