Training in robotic pancreatic surgery

Abstract

The aim of this narrative review is to discuss current training for the robotic approach to pancreatic surgery and the potential use of machine learning to progress robotic surgical training. A literature search using PubMed and MEDLINE was conducted to investigate training programmes in robotic pancreatic surgery and advances in the use of artificial intelligence for training. The use of virtual reality can assist novice robotic surgeons in learning basic surgical skills. The use of automated video analytics can also improve surgical education to enable self-directed learning both within and outside the operating room. The emerging role and novel applications of machine learning in robotic surgery could shape future training by aiding the autonomous recognition of anatomical structures in the surgical field, instrument tracking and providing feedback on surgical competence. Training should be standardised to ensure the attainment of assessment benchmarks and include virtual simulation basic training in addition to procedural-specific training. Standardised procedural techniques should be used to improve patient safety, theatre efficiency and the continuation of robotic practice.

Keywords

Pancreatic / surgery / robotics / machine learning

References

[1] Qin R,Wolfgang CL.International expert consensus on laparoscopic pancreaticoduodenectomy.Hepatobiliary Surg Nutr2020;9:464-83 PMCID:PMC7423539

[2] Keus F,Gooszen HG.Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.Cochrane Database Syst Rev2006;(4):CD006231

[3] Jaschinski T,Eikermann M,Sauerland S.Laparoscopic versus open surgery for suspected appendicitis.Cochrane Database Syst Rev2018;11:CD001546 PMCID:PMC6517145

[4] Liang S,Jayaraman S.Laparoscopic pancreatectomy: indications and outcomes.World J Gastroenterol2014;20:14246-54 PMCID:PMC4202353

[5] Deoliveira ML,Schafer M.Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy.Ann Surg2006;244:931-9 PMCID:PMC1856636

[6] Heemskerk J,Maessen JG,Bouvy ND.Advantages of advanced laparoscopic systems.Surg Endosc2006;20:730-3

[7] Wang M,Liu J.Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1029 patients.Ann Surg2021;273:145-53

[8] Adam MA,Dinan MA.Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients.Ann Surg2015;262:372-7

[9] Sharpe SM,Wang CE.Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Database.J Am Coll Surg2015;221:175-84

[10] van Hilst J,Bosscha K.Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial.Lancet Gastroenterol Hepatol2019;4:199-207

[11] de Rooij T, van Hilst J, Topal B, et al; Dutch Pancreatic Cancer Group. Outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LAELAPS-2).Ann Surg2019;269:344-50

[12] Choi S,Lee S.Trends in clinical outcomes and long-term survival after robotic gastrectomy for gastric cancer: a single high-volume center experience of consecutive 2000 patients.Gastric Cancer2022;25:275-86

[13] Guerrini GP,Magistri P.Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis.Int J Surg2020;82:210-28

[14] Gall TM,Cunningham D,Jiao LR.Transition from open and laparoscopic to robotic pancreaticoduodenectomy in a UK tertiary referral hepatobiliary and pancreatic centre - early experience of robotic pancreaticoduodenectomy.HPB (Oxford)2020;22:1637-44

[15] Prete FP,Prete F.Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials.Ann Surg2018;267:1034-46

[16] Basiri A,Tabatabaei S,Laguna MP.Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?.World J Urol2018;36:609-21

[17] Lanfranco AR,Desai JP.Robotic surgery: a current perspective.Ann Surg2004;239:14-21 PMCID:PMC1356187

[18] Diana M.Robotic surgery.Br J Surg2015;102:e15-28

[19] Giulianotti PC,Bianco FM.Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience.Surg Endosc2010;24:1646-57

[20] Ji WB,Zhao ZM,Lu F.Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience.Ann Surg2011;253:342-8

[21] Zureikat AH,Zenati MS.500 minimally invasive robotic pancreatoduodenectomies: one decade of optimizing performance.Ann Surg2021;273:966-72 PMCID:PMC7871451

[22] Sheetz KH,Dimick JB.Trends in the adoption of robotic surgery for common surgical procedures.JAMA Netw Open2020;3:e1918911 PMCID:PMC6991252

[23] Childers CP.Estimation of the acquisition and operating costs for robotic surgery.JAMA2018;320:835-6 PMCID:PMC6142989

[24] Panni RZ,Hawkins WG,Asbun HJ.National pancreatic fistula rates after minimally invasive pancreaticoduodenectomy: a NSQIP analysis.J Am Coll Surg2019;229:192-199.e1

[25] Lam K,Purkayastha S.Uptake and accessibility of surgical robotics in England.Int J Med Robot2021;17:1-7

[26] Hanna T.Robotics in HPB surgery.Ann R Coll Surg Engl2018;100:31-7 PMCID:PMC5956575

[27] Lai ECH.Training robotic hepatectomy: the Hong Kong experience and perspective.Hepatobiliary Surg Nutr2017;6:222-9 PMCID:PMC5554762

[28] Hawksworth J,Holzner ML.Robotic hepatectomy is a safe and cost-effective alternative to conventional open hepatectomy: a single-center preliminary experience.J Gastrointest Surg2021;25:825-8

[29] Bozkurt E,Hilal MA.What is the current role and what are the prospects of the robotic approach in liver surgery?.Cancers2022;14:4268 PMCID:PMC9454668

[30] Conlon KC,van Hilst J.Minimally Invasive Pancreatic Resection Organizing CommitteeMinimally invasive pancreatic resections: cost and value perspectives.HPB (Oxford)2017;19:225-33

[31] Ryoo DY,Hamad A.Mitigation of the robotic pancreaticoduodenectomy learning curve through comprehensive training.HPB (Oxford)2021;23:1550-6

[32] Liu R,Palanivelu C.International consensus statement on robotic pancreatic surgery.Hepatobiliary Surg Nutr2019;8:345-60 PMCID:PMC6700012

[33] Asbun HJ,Vissers FL.International Study Group on Minimally Invasive Pancreas Surgery (I-MIPS)The miami international evidence-based guidelines on minimally invasive pancreas resection.Ann Surg2020;271:1-14

[34] Herron DM.SAGES-MIRA Robotic Surgery Consensus GroupA consensus document on robotic surgery.Surg Endosc2008;22:313-25; discussion 311

[35] de Rooij T, van Hilst J, Boerma D, et al; Dutch Pancreatic Cancer Group. Impact of a nationwide training program in minimally invasive distal pancreatectomy (LAELAPS).Ann Surg2016;264:754-62

[36] Hogg ME,Clavien PA.Minimally Invasive Pancreatic Resection Organizing CommitteeTraining in minimally invasive pancreatic resections: a paradigm shift away from “See one, Do one, Teach one”.HPB (Oxford)2017;19:234-45

[37] Knab LM,Zeh HJ 3rd.Towards standardized robotic surgery in gastrointestinal oncology.Langenbecks Arch Surg2017;402:1003-14

[38] Radi I,Alterio RE.Feasibility, effectiveness and transferability of a novel mastery-based virtual reality robotic training platform for general surgery residents.Surg Endosc2022;36:7279-87 PMCID:PMC8863393

[39] Mark Knab L,Khodakov A.Evolution of a novel robotic training curriculum in a complex general surgical oncology fellowship.Ann Surg Oncol2018;25:3445-52

[40] LEARNBOT. European consortium on minimally invasive pancreatic surgery. Available from: http://e-mips.com/learnbot [Last accessed on 8 Dec 2022]

[41] Adam MA,Youngwirth L,Roman SA.Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States.JAMA Surg2017;152:336-42 PMCID:PMC5470427

[42] Torphy RJ,Halpern A.Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers.Ann Surg2019;270:1147-55

[43] Ceccarelli G,Fontani A,Rocca A.Robot-assisted liver surgery in a general surgery unit with a “Referral Centre Hub&Spoke Learning Program”. Early outcomes after our first 70 consecutive patients.Minerva Chir2018;73:460-8

[44] Gall TMH,Soomro N,Jiao LR.Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves.BJS Open2020;4:1100-8 PMCID:PMC7709379

[45] Zhang T,Gao YX,Liu R.The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center.Surg Endosc2019;33:2927-33

[46] Lu C,Mou YP.Analysis of learning curve for laparoscopic pancreaticoduodenectomy.J Vis Surg2016;2:145 PMCID:PMC5637755

[47] Gall TMH,Elliott JA,Fong Y.The Atlantic divide: contrasting surgical robotics training in the USA, UK and Ireland.J Robot Surg2022;

[48] Takagi K,Yoshida R.Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: a technical note.World J Surg Oncol2021;19:55 PMCID:PMC7896387

[49] Rice MK,Bellon J.Association of mentorship and a formal robotic proficiency skills curriculum with subsequent generations’ learning curve and safety for robotic pancreaticoduodenectomy.JAMA Surg2020;155:607-15 PMCID:PMC7240650

[50] Yamashita R,Do RKG.Convolutional neural networks: an overview and application in radiology.Insights Imaging2018;9:611-29 PMCID:PMC6108980

[51] Malik P, Pathania M, Rathaur VK. Overview of artificial intelligence in medicine.J Family Med Prim Care2019;8:2328 PMCID:PMC6691444

[52] Deo RC.Machine learning in medicine.Circulation2015;132:1920-30 PMCID:PMC5831252

[53] Mascagni P,Urade T.A computer vision platform to automatically locate critical events in surgical videos: documenting safety in laparoscopic cholecystectomy.Ann Surg2021;274:e93-5

[54] Malpani A,Lin HC,Taylor RH.Effect of real-time virtual reality-based teaching cues on learning needle passing for robot-assisted minimally invasive surgery: a randomized controlled trial.Int J Comput Assist Radiol Surg2020;15:1187-94

[55] Twinanda AP,Mutter D,de Mathelin M.EndoNet: a deep architecture for recognition tasks on laparoscopic videos.IEEE Trans Med Imaging2017;36:86-97

[56] Jin Y,Chen H.SV-RCNet: workflow recognition from surgical videos using recurrent convolutional network.IEEE Trans Med Imaging2018;37:1114-26

[57] Hashimoto DA,Witkowski ER.Computer vision analysis of intraoperative video: automated recognition of operative steps in laparoscopic sleeve gastrectomy.Ann Surg2019;270:414-21 PMCID:PMC7216040

[58] Morita S,Masumoto H,Kamiura N.Real-time extraction of important surgical phases in cataract surgery videos.Sci Rep2019;9:16590 PMCID:PMC6851365

[59] Kitaguchi D,Matsuzaki H.Real-time automatic surgical phase recognition in laparoscopic sigmoidectomy using the convolutional neural network-based deep learning approach.Surg Endosc2020;34:4924-31

[60] Ward TM,Ban Y.Computer vision in surgery.Surgery2021;169:1253-6

[61] Kitaguchi D,Matsuzaki H.Automated laparoscopic colorectal surgery workflow recognition using artificial intelligence: experimental research.Int J Surg2020;79:88-94

[62] Yamazaki Y,Matsuda T.Automated surgical instrument detection from laparoscopic gastrectomy video images using an open source convolutional neural network platform.J Am Coll Surg2020;230:725-732.e1

[63] Lee D,Kwon H,Lee KE.Evaluation of surgical skills during robotic surgery by deep learning-based multiple surgical instrument tracking in training and actual operations.J Clin Med2020;9:1964 PMCID:PMC7355689

[64] Khalid S,Grantcharov T,Rudzicz F.Evaluation of deep learning models for identifying surgical actions and measuring performance.JAMA Netw Open2020;3:e201664

[65] Luongo F,Nguyen JH,Hung AJ.Deep learning-based computer vision to recognize and classify suturing gestures in robot-assisted surgery. Surgery 2021;169:1240-4. PMCID:PMC7994208

[66] Madani A,Altieri MS.Artificial intelligence for intraoperative guidance: using semantic segmentation to identify surgical anatomy during laparoscopic cholecystectomy.Ann Surg2022;276:363-9 PMCID:PMC8186165

[67] Mascagni P,Alapatt D.Artificial intelligence for surgical safety: automatic assessment of the critical view of safety in laparoscopic cholecystectomy using deep learning.Ann Surg2022;275:955-61

[68] Stulberg JJ,Kreutzer L.Association between surgeon technical skills and patient outcomes.JAMA Surg2020;155:960-8 PMCID:PMC7439214

[69] Hung AJ,Che Z.Utilizing machine learning and automated performance metrics to evaluate robot-assisted radical prostatectomy performance and predict outcomes.J Endourol2018;32:438-44

[70] Jarc AM.Viewpoint matters: objective performance metrics for surgeon endoscope control during robot-assisted surgery.Surg Endosc2017;31:1192-202 PMCID:PMC5315708