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This is particularly the case with urologic and gynecologic oncology, he says. Training and credentialing for cosmetic surgeons and OR staff are essential aspects of a robotic surgery program, Amori says. Intuitive offers product training. Clinical training is conducted on the peer-to-peer basis. A surgeon’s first robotic operations typically are proctored by a far more experienced surgeon. A healthcare facility or surgeon buy the proctoring service as part of training they have individually determined to be always a credentialing requirement.

Intuitive simply coordinates among the hospital, surgeon, and proctor. Hospitals determine their own credentialing criteria. Some doctors are able to conduct robotic surgery independently after a small number of cases overseen by a proctor. Intuitive suggests hospitals establish a da Vinci surgery steering committee to coordinate departments, oversee situations, set up guidelines for credentialing and proctoring, and analyze and survey on operative and clinical, final results data.

Physicians say there is a learning curve with robotic surgery, just as there has been regular laparoscopy. Studies estimate the learning curve for regular laparoscopic and robotic radical prostatectomy at 150 or even more cases, notes a 2009 Journal of the American Medical Association article. The learning curve for a surgeon to become more comfortable with robotic hysterectomy is approximately 20, Buttin says. The greater cases doctors do, the better they perform, research shows. One concern: Some doctors might not manage enough cases yearly to maintain their skills, Amori says.

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Part of the surgeon’s and OR staff training must be to know how to proceed if the automatic robot has a problem or the patient’s condition abruptly crashes. The FDA’s Manufacturer and User Facility Device Experience reviews show hundreds of cases of equipment issues with the da Vinci. The majority are minor, and the surgery continues; however, some require the physician to convert to open up surgery.

The OR team must “practice moving that machine away from an individual and pretending you have to go to open surgery,” Amori says. Some fear a generation of da Vinci-trained doctors shall lack strong regular laparoscopy or open up surgery skills. If the robot failed completely, most surgeons could convert to open surgery and complete the operation, Bessler says. If enough new physicians choose robotic laparoscopic surgery and also have less trained in regular laparoscopy and open surgery, the demand for robots shall grow.