The necessity of adequate training in robotic surgery
We have been concerned this week by a high profile report in the news of a patient who died during a robotic mitral valve procedure in Newcastle in 2015.
Clearly our thoughts are with the patient’s family and friends, who have lost a man who the coroner said may have lived had the procedure been performed with the standard open approach. It was reported that the primary surgeon hadn’t completed much training and had received little one-to-one tuition, and that the two external mentors left part of the way through the operation. Open conversion occurred when the robotic procedure had to be abandoned due to bleeding obscuring the vision.
As a robotic trainer and mentor for urological surgery I was concerned about some of the background to the story. This was the one of the first times this procedure had occurred in the UK and certainly the first in this hospital.
As robotics expands into different specialties, the need for a more formal and standardised training programme is increasingly required. Unlike most large US hospitals there are only a few UK centres that have a formal credentialing process for new robotic surgeons.
In urology we are lucky as we have established a more structured training programme and have many young fellowship trained surgeons. The penetration is such that over 80% of 7000 annual radical prostatectomies are carried out robotically – so most centres are now well established and well over their initial learning curves, with excellent national results.
As a result of the increasing uptake in robotic surgery now occurring in gynaecology, upper and lower GI surgery, ENT and thoracics, the UK needs a pan-speciality training and accreditation programme to ensure that minimum competencies are defined and patients are not placed at risk during initial cases. Without this there is a possibility that results may get worse before they get better.
What are your thoughts? Is more training the solution to prevent future surgical tragedies?