Docking Docking is a robotic term defined as the attachment of the robotic arms to the robotic trocars inserted in the patient. A mean docking time of about 3 minutes was reported in an initial study of 88 patients undergoing robotic hysterectomy (6). Docking times improved progressively after groups of 10 patients each.
There is a mandatory training course of 2 days to obtain certification in robotics provided by the manufacturing company Intuitive, Inc (Sunnyvale, CA) in centers located in the United States, Europe, and Asia. The gynecologist learns the robotic system and logs about 8 hours of dry and animal laboratory tasks. Residents or fellows completing training programs with robotics must demonstrate proficiency with documented basic robotic training and successfully perform a minimum of 10 robotic surgeries, preferably of the same type, and obtain a letter from the program director attesting to their level of robotic proficiency. Credentialing is dependent on each hospital credentialing body and is different for each institution: while some require robotic practice in five animals and having a proctor for the first five robotic surgeries, others mandate having a proctor for only two to five robotic procedures prior to obtaining robotic privileges.
Assistant An assistant is needed for docking, switching robotic instruments, solving robotic arm collision, retrieving small specimens, retracting tissue, and for the use of instruments not available with robotic technology, such as a vessel-sealing device and suction and irrigation.
The assistant must be trained in robotics and be very knowledgeable about the procedure, because the surgeon is seated in a separate place and not scrubbed.
The robotic teaching console allows the surgeon and the resident or fellow to each have his or her own console while having dual control. The surgeon is able to demonstrate the performance of a specific task to the trainee, or to assist the resident with one robotic arm, or prevent an imminent injury by disengaging the robotic arms from the resident’s hands, while both surgeon and resident are seated and viewing the stereoscopic image. The benefits of the teaching console were not compared to standard laparoscopic teaching to evaluate advantages. The half million dollar cost of the teaching console is a large disadvantage.
Previous laparoscopic experience was considered an advantage to learning robotics. Multiple reports show that transitioning from laparotomy to robotics is easier than transitioning from laparoscopy to robotics (15). A large number of gynecologic oncologists and gynecologists incorporated robotics into their daily practice without having incorporated laparoscopy into their practice or performing advanced laparoscopic procedures. In one study the initiation of robotics in a gynecologic oncology program reduced laparotomy from 78% to 35% in the first year of implementation and it increased the number of minimally invasive procedures from 22% performed by laparoscopy to 65% being robotic assisted (15). Thus, robotic technology is relatively easy to use, associated with a short learning curve, and comfortable for the surgeon (15– 17). It is less stressful to learn robotics than laparoscopy. Reduced stress and ease of learning with robotics compared to laparoscopy was demonstrated when 16 medical students were exposed to both techniques (5).