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D-H Physicians to Train on da Vinci Robotic-Assist Surgery System

D-H Physicians to Train on da Vinci Robotic-Assist Surgery System

These training grants reflect Dartmouth-Hitchcock's commitment to robotic-assisted surgery to provide the highest level of patient care.

Elias Hyams, MD

Soon, surgeons who perform minimally invasive surgery at Dartmouth-Hitchcock Medical Center (DHMC) will be among the best-trained in the world using the innovative da Vinci robotic surgical assist system, thanks to two grants from Intuitive Surgical, the da Vinci system's developer and vendor.

"These training grants reflect Dartmouth-Hitchcock's commitment to robotic-assisted surgery to provide the highest level of patient care," said D-H urologist Elias Hyams, MD, who co-wrote one of the successful grant applications. The training, which will be conducted on a da Vinci Skills Simulator located in the Patient Safety Training Center — D-H's "Sim Center" — will be useful for learning as well as research purposes, Hyams noted. "We will be using the simulator for training but also to assess the learning curve our doctors need to become comfortable with the da Vinci system," he said. "It will help us make the training better in order to use da Vinci optimally."

Robotic surgery has been available at DHMC since 2007, with gynecologic oncologists and urologists as the main users. To date more than 2,000 robotic surgeries have been performed at DHMC. "I've seen firsthand how robotic surgery technology has improved the care of my uterine cancer patients," said Evelyn Fleming, MD, gynecologic oncologist, "taking what had been a rather involved abdominal surgery with a large incision and a three-to-five-day hospital stay and transforming it into a surgery done with sub-centimeter incisions and an overnight stay. Patients love it and are able to get back to their usual activities much sooner."  Fleming has been so impressed with the robotic surgery platform that she initiated a multidisciplinary users group of robotic surgeons and nurses called the Robotic Surgery Committee.  One of the simulation grant applications arose out of this committee in a cross-discipline joint effort between Fleming and Hyams with input from the entire committee.

DHMC is just one of five medical centers in the U.S. to have been awarded the one-year da Vinci training grants by Intuitive Surgical. Medical centers were selected based on the scientific merits of their proposals, their specialty's relevance to robotic-assisted minimally invasive surgery, bibliographies, proof of prior work and intent to publish their surgery simulation results. The technology grant recipients were selected from the dozens of applications received.

D-H physicians used to have to go out of state for da Vinci training, but now all such training will be conducted in-house. The simulator arrived at DHMC in early November, and training will begin within the next four weeks, Hyams said. In addition to the multidisciplinary grant by Drs. Fleming and Hyams, Leslie DeMars, MD, wrote a successful grant application for da Vinci Simulator training for OB/GYN.  The da Vinci Skills Simulator is intended to augment, not replace, existing training programs for the system.

"We're the only academic medical center in New Hampshire, so this means that not only will we be able to train and educate our residents better, but we will be able to develop curricula to extend the training to physicians from outside D-H," said DeMars. "Robotic surgery is here to stay, and we have an obligation as an academic medical center to train not only the present generation but future generations of physicians in this innovative technology."

The da Vinci Surgical Systems are designed to help doctors perform minimally invasive surgery and are not programmed to perform surgery on their own. Instead, the surgery is performed entirely by a doctor, who controls the system, according to Intuitive Surgical. The systems offer doctors high-definition 3-D vision, a magnified view, and robotic and computer assistance. They use specialized instrumentation, including a miniaturized surgical camera and wristed instruments (i.e., scissors, scalpels and forceps) designed to help with precise dissection and reconstruction deep inside the body.

According to Hyams, the da Vinci system is particularly useful for inside-the-body suturing, but the system's uses continue to expand.  In the near future, da Vinci will be used to facilitate and optimize general and thoracic surgery as well, he said.

"It has been very exciting to work with colleagues from across surgical disciplines who share a passion for surgical innovation. The robotic simulator will help us to continue to advance our robotic surgery program so that we may continue to offer state-of-art care to our patients," remarked Fleming.

"Our goal is to see the skills surgeons develop during simulation practice transfer to actual surgery," said Myriam Curet, MD, senior vice president and chief medical officer at Intuitive Surgical. "Early research suggests that case times may actually be shorter for surgeons who spend time doing simulation. Our hope is that future studies show that regular simulation practice also results in improved patient outcomes."

In addition to Dartmouth-Hitchcock, other recipients of da Vinci Simulator training grants include Duke University, Oregon Health Sciences University, University of Texas Southwestern and Washington University School of Medicine in St. Louis.