A comprehensive method to train residents in robotic hysterectomy techniques

Training residents to perform robotic surgery poses several challenges. We describe a comprehensive method, beginning with a dry lab, and progressing through bedside assisting, then segmental involvement, to full participation, for residents to train and obtain credentials in robotic hysterectomy. From August 1, 2006 through July 31, 2009 a training method was developed at the University of South Alabama on the Gynecologic Oncology service. A dry lab which closely simulates specific tasks performed in a robotic hysterectomy was accompanied by resident observation of robotic surgery, and followed with progressive involvement in the robotic console. This culminated in their completion of dozens of complete robotic hysterectomies. Sixteen residents completed the dry lab and 228 robotic cases were performed, 190 of which were hysterectomy; 161/190 (84.7%) included resident participation, 103/190 (54.2%) included resident participation in the console, and in 65/190 (34.2%) residents completed the hysterectomy procedure. The mean time for resident robotic hysterectomy was 45.08 min (range = 13-92 min), and the mean time to tie a single figure-of-eight suture in the vaginal cuff was 4.41 min (range = 2.25-9.25). Complications were similar for resident and attending surgeon cases. Using a dry lab as well as graded introduction to robotic surgery which begins with observation, progresses through bedside assisting, and culminates in complete hysterectomy by residents, we have demonstrated a method to train and credential Ob/Gyn residents in robotic hysterectomy.