A novel method for training residents in robotic hysterectomy

Standard surgeon training for robotic hysterectomy currently includes the use of a porcine lab to gain experience using the daVinci Surgical System. Residents in obstetrics/gynecology are taught using a novel dry lab which mimics the tasks specific to a robotic hysterectomy. This technique may ultimately aid in the credentialing of gynecologic surgeons, obviating the need for the porcine lab. A lab simulating the anatomy of key tasks in the hysterectomy with salpingo-oophorectomy has been developed using readily available materials. Residents perform simulated tasks under direct supervision. Time to complete, a subjective grading score, and any errors made are recorded and compared amongst the participants. From April 2007 through April 2008, 16 residents participated in the lab. Mean times (range, standard deviation) to perform simulated procedures were: 177.3 s (100–270, 48.2) for dexterity training, 71.9 s (32–171, 34.6) for identification of the ureter and sealing/dividing the infundibulopelvic ligament, 157.8 s (60–300, 76.8) for dissecting the bladder flap, 77 s (25–148, 34.8) for skeletonizing the uterine arteries, and 516 s (270–946, 237.8) for suturing the vaginal cuff. Since completing the lab, five residents have completed a total of 16 robotic hysterectomies on live patients, with no training-related patient complications. This lab closely mimics those segments of a hysterectomy on humans. Here, we describe a technique to train residents for robotic hysterectomy and bilateral salpingo-oophorectomy without the use of a porcine lab.