Kidney and Urology Institute, Medanta, The Medicity, Gurgaon
Consultant Urology, Robotics and Kidney Transplant
Introduction: Traditional learning techniques in era of open surgery continue to play a major role in teaching but face new challenges in era of Robotic surgery. Robotic surgery gives perception of distance and switching between teacher and trainee is a long and complex action. This requires a great amount of time and patience from proctor. It contributes to increased anxiety and may compromise safety. Perception of danger is enhanced due to loss of haptic feedback. Advent of ‘‘Dual Console’’ setup allows to overcome above drawbacks. We present a video demonstrating role of Dual console as an innovative training tool for step ladder learning approach to Robotic Partial Nephrectomy (RPN).
Material and methods: A 42 year female underwent right RPN for 5 cm lower polar renal mass. Proctoring and proctored surgeon sat at master and secondary consoles respectively. Fellows were made to place ports and dock the robot. From here on proctored surgeon takes over console work for graded stepwise mobilisation of colon, lifting of ureteric pedicle, dissection and control of hilum and tumour scoring. As the proctored surgeon has grown over an experience of 79 RPNs, the proctoring surgeon decided to let proctored surgeon cross next step while learning this advanced procedure. Proctored surgeon excises the tumour and console is swapped to proctoring surgeon, who performs renorraphy and subscribes to safe warm ischemia time limits.
Results: Total operative, console and warm ischemia times were 118, 82 and 25 minutes respectively. Estimated blood loss was 125 millilitres. Final pathology was clear cell carcinoma pT1bNxMx with clear margins.
Conclusion: Dual console set up provides a strong collaboration between two surgeons and can be a powerful teaching tool with unique advantages. This adds to safety and efficacy in a teaching set up especially during critical steps in complex surgeries as partial nephrectomy.
Narrated video presentation, with PPT’s, Photos, diagrams and robotic surgery videos, 06:49