Ann Thorac Surg 2009;88:527-528. doi:10.1016/j.athoracsur.2009.05.035
© 2009 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Jacob Bergsland, MD
Interventional Center, Rikshospitalet, Sognsvannveien 20, Oslo, N-0027 Norway
(Email: nielsb{at}aol.com).
Development of new procedures and training in how to perform them is essential for progress within the surgical community. As surgical procedures get more complex, both theoretic and technologic knowledge as well as hands on practice becomes increasingly important. Simultaneously, senior specialists may be less interested in teaching such complex procedures due to increased production pressures. Robotic procedures require the ability not only to work using indirect vision but also to manipulate 2 or more robotic arms, as well as the placement of ports, among other skills. These demands make a robotic procedure more complex than open surgical operations [1].
Dr Schachner and colleagues [2] deserve credit for designing a structured program for teaching robotic coronary artery bypass grafting (CABG). Dr Bonattis' team from Innsbruck has been leaders in this field and now demonstrates its willingness and ability to extend the clinical experience with such techniques to trainees. If robotic cardiac surgery is to become an important part of the specialty, dissemination of such procedures into the mainstream of coronary and valvular surgery is essential. Clinical implementation will require a major effort of the pioneers in robotic cardiac surgery. A similar situation was seen with off-pump CABG, where lack of organized training of residents may have been detrimental to a wider dissemination of such techniques [3].
Robotic cardiac surgery has by some been considered a technology looking for an application. So-called totally endoscopic CABG (TECAB or endoCAB) has been so difficult that relatively few skilled surgeons have performed the procedure successfully. Improvement in robotic technology and availability of automatic anastomotic devices may make endoscopic robotic CABG a realistic and competitive alternative to endovascular stenting procedures.
Dr. Schachner and coworkers [2] have demonstrated a practical method of teaching robotic CABG without sacrificing patient safety or dramatically increase operating time. Their stepwise approach to the learning process described in this article clearly outlines the increasing skills obtained by the learners and gives their approach a well-organized character, while preserving patient safety and ethical management. The approach by Dr Schacner and his team may be used to effectively increase robotic skills among cardiac surgeons.
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References
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- Donias HW, Karamanoukian RL, Glick PL, Bergsland J, Karamanoukian HL. Survey of resident training in robotic surgery Am Surg 2002;68:177-181.[Medline]
- Schachner T, Bonaros N, Wiedemann D, et al. Training surgeons to perform robotically assisted totally endoscopic coronary surgery Ann Thorac Surg 2009;88:523-528.[Abstract/Free Full Text]
- Ricci M, Karamanoukian HL, D'Ancona G, et al. Survey of resident training in beating heart operations Ann Thorac Surg 2000;70:479-482.[Abstract/Free Full Text]
Related Article
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Training Surgeons to Perform Robotically Assisted Totally Endoscopic Coronary Surgery
- Thomas Schachner, Nikolaos Bonaros, Dominik Wiedemann, Felix Weidinger, Gudrun Feuchtner, Guy Friedrich, Guenther Laufer, and Johannes Bonatti
Ann. Thorac. Surg. 2009 88: 523-527.
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