THE “COOL FACTOR”
Training for certification on a da Vinci is intensive, commented Susie Kittle, RN, BSN, CNOR, a the service coordinator for Surgical Services and robotics coordinator at Northside Hospital in Atlanta, Georgia. Kittle is a 40-year veteran nurse, with 20 years’ experience as a perioperative nurse. Northside bought its first da Vinci in 2005.
Product training comes first, and begins with an online course that takes less than a week to complete, explained Kittle. Nurses learn how robotic surgery is performed and observe how MIS helps reduce surgical complications, blood loss, and the length of hospital stays. Afterwards, nurses receive hands-on training with instructors from the manufacturer on how to operate and troubleshoot da Vinci’s touch-screen computer system and program specific surgical instructions for the procedure and which instruments will be used, such as a stapler vs a needle driver. During this training period, nurses also work with the laparoscopic trocars used to allow the robotic arms to enter the patient and the fitting and preparation of each robotic surgical instrument. How to rectify non-life-threatening presurgical computer glitches, align the robot’s 3D viewing camera to allow for the best view of the surgical site, and perform smooth interoperative instrument adjustments on the robot are also covered during this initial training phase (Table 1).
TABLE 1. da Vinci Surgical System training curriculum
I: Introduction to robotic surgery and value of MIS
II: Robot surgical preparation and computer system training
|An instructor from Intuitive Surgical|
|Clinical training (skills application)||
III: Post-system clinical training in a team’s specific field: Oncology, cardio, etc.
IV: Advanced clinical training, observing other robotic operating room teams
|Independent surgeons and institutions working with an Intuitive instructor|
|Continuing education||Continuing education, peer-to-peer education||Independent surgeons, hospitals, clinics, and societies/academic institutions|
Product training and clinical training are taught separately for operating room teams learning the da Vinci Surgical System.
Key: MIS, minimally invasive surgery.
Nurses then follow their surgical team for approximately 3 weeks of clinical training with an instructor from Intuitive and an experienced robotics surgeon. During this stage, the nurse and surgical team learn the clinical side of robotic surgery specific to their surgical specialty.
Upon completion of training, “the cool factor sets in and you really begin to see the subtle differences in robotic surgery,” said Kittle. “Like the way patients react when they enter the OR and see the robot, or watching as the surgeon breaks scrub before getting behind the console to perform the procedure.” Robotic assisted cancer surgery kicks even the most seasoned nurse’s game up an extra notch, said Kittle, and you get a unique sense of cohesive teamwork during the procedures.
“As a nurse it’s exciting to work around such an advanced piece of equipment. You really feel you are working at the cutting edge of your profession. Upgrades and new parts [for] the (robotic) system are always being introduced, so it doesn’t get boring.”
Nurses working with robotic surgical teams notice not just the newness but also the little things that are missing, said Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC, a perioperative nursing specialist with Association of Operating Room Nurses (AORN). “One big challenge is that the surgeon is not across the table so that whole intuitive sense that forms between a surgeon and his nursing staff is kind of gone. Instead of a glance sometimes the surgeon needs to look up from the console and tell you exactly what he needs,” she said.
The connection between the surgeon’s console and the patient operating table is little more than a secure high-speed Internet connection so surgeons may soon not even need to be in the OR to perform robotic surgery. This distributed OR environments would present a whole new set of challenges for nurses in robotic surgery, but for now the FDA requires that surgeons be physically in the same room as the patient they are operating on.