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BIARGS Training curriculum

A. Pre-requisite

  • Team working
  • Anticipation
  • Understanding robotic surgery requires increased cognitive work load
  • Team need to be efficiency

B. Educational objectives of trainee attending robotic theatre

  • Excellent opportunity to learn surgical anatomy
  • Learn surgical approach and principles in undertaking complex case
  • Develop leaderships skills as main bed side assistant surgeon
  • Learn and demonstrate situational awareness and human factor (NOTSS)
  • Assist in complex cases
  • Progress to ATSM

Practical session (In-house or training course) to learn draping, docking, undocking, change of instruments and principles of emergency drill. Certificate of attendance required.

CiP 1 Competencies in Practice: The practitioner is able to practice as a gynaecological Robotic Surgeon in MIS unit within a multidisciplinary team.

Trainees / Advanced surgical practitioner should have assisted with laparoscopic cases before assisting with robotic cases.
Orientation & Preparation Competence Level
Level 1 Level 2 Level 3 Level 4
Nurse ST1/ST2 Nurse ST3/ST4/ST5
SECOND ASSISTANT (Bottom end) FIRST ASSISTANT
Date Signature Date Signature Date Signature Date Signature
Orientation of robotic theatre
Demonstrate effective team working
Demonstrate effective communication skills within theatre tram
Demonstrate situational awareness
Demonstrate importance of Human factor
Sterile preparation of robot
Bedside assistant ( level 2)
Reflective practice
_ _
Knowledge Competence Level
Level 1 Level 2 Level 3 Level 4
Date Signature Date Signature Date Signature Date Signature
Completion of the online theoretical training package
Awareness of the ergonomics of robotic assistance
Familiar with robotic components and instrumentation
Awareness of other modalities, benefits and potential complications with robotic surgery
Knowledge of different docking positions and the indications
Understands reasons for arm clashing and methods of correction
Knowledge of the potential complications of electro diathermy
knowledge of principles of laparoscopy and robotic surgery
Situational awareness
Communication skills

CiP 2 Competencies in Practice: The practitionar provides high quality perioperative and Robotic assisted gynaecological surgical care within a MIS unit.

Robotic Assistant competence
Orientation & Preparation Competence Level
Level 1 Level 2 Level 3 Level 4
Nurse ST1/ST2 Nurse ST3/ST4/ST5
SECOND ASSISTANT (Bottom end) FIRST ASSISTANT
Date Signature Date Signature Date Signature Date Signature
Knowledge of the operative room setup of the robotic system
Aware of principles of the robotic system
Be able to drape the Robot
Be able to respond to system errors
Able to drive the robot
Knowledge of how to position patient for robotic surgery
Undertake vaginal preparation for a robotic procedure
Able to insert McCartney tube in vagina if required
Able to insert uterine manipulator if required
Be able to undertake vaginal preparation & insert a rectal probe if required
Understand and demonstrate use of different methods of maintaining pneumoperitoneum
Demonstrate understanding port placement
Be able to dock the robotic system
Understand different docking positions and able to dock the robot
Be able to maintain a clear image by cleaning/changing the camera
Be able to insert, change and remove robotic instruments
Be able to unVessel sealern for clashing and adjust the arm positions
Have understanding of the appropriate use of assistant port
Demonstrates of use of suction and maintaining clear operative field
Able to introduce and present loaded needle
Able to cut the suture with laparoscopic scissors
Safe retrieval of needle
Demonstrate understanding of communication with scrub team and needle/swab count
Demonstrate introduction and retrieval of specimen bag/ swabs
Undocking and port closure (3 cases – level 4)
Be able to close incisions and port sites closure
Be able to perform an emergency undocking procedure
Demonstrate understanding of specimen handling and histology/cytology requests
Demonstrate effective communication with anaesthetic , theatre team and console surgeon
Demonstrate skills of communication with recovery and ward staff
Online modules
- Vessel sealer
- Diathermy
- Needle drive
Robot console simulation
Demonstrate camera control and set up visual field
Demonstrate multi-arm control of the robotic instruments
Demonstrate hand-eye instrument coordination
Demonstrate wrist articulation
Demonstrate clutching of the robotic instruments
Demonstrate atraumatic tissue handling
Safe tissue cutting with the robotic system 
Maintain safety of operative field
Demonstrate blunt dissection with the robotic system
Demonstrate micro dissection with the robotic system 
Use of diathermy and colpotomy 
Demonstrate plan for surgucal specimen retrieval methods  
Demonstrate use of needle driving with the robotic system   
Demonstrate knot tying with the robotic system     
Demonstrate suture handling with the robotic system     
Demonstrate continuous and interrupted suturing with the robotic system       
Understand the potential risks and ability to make appropriate operative decisions     
Be able to manage surgical complications (bowel/urinary/vascular injuries)    
Demonstrate effective communication with anesthetic , threatre team and console surgeon
Procedural tasks Level 1 Level 2 Level 3 Level 4
Date Signature Date Signature Date Signature Date Signature
Sealing and dividing round ligaments
Identifying ureters and sealing and dividing ovarian vessels
Incising vesicouterine peritoneum and developing vesicovaginal space
Sealing and dividing uterine vessels
Performing colpotomy
Suturing vaginal cuff
Robot assisted hysterectomy (3 cases level 3)
Robot assisted BSO (3 cases level 3)
Training Modules
Basic local training
Simulator training
Online module
Wet lab
Competence based training (Level 1 to 4)
Ist assistance sign off
ST6/7/ATSM
Assesments
Audit of cases
OSATS
DOPS
CBD
NOTSS
Reflective practice
Annual update