New System to Improve Reporting of Robotic Surgeries | Loyola Medicine
Tuesday, September 26, 2017

New System Proposed for Logging Physician Experience in Robotic Surgery

"RoboLog" Developed by Loyola Medicine Urologic Surgeons

Kristin Baldea, MD, Gopal Gupta, MD

MAYWOOD, IL –  Loyola Medicine physicians have proposed a simple new system to improve the reporting of robotic surgeries performed by surgeons in training.

The system, called RoboLog, was successfully piloted on 310 urologic robotic surgeries, according to a study published in the Journal of Surgical Education by first author Kristin Baldea, MD, senior author Gopal Gupta, MD, and colleagues.

Robotic-assisted surgery is gaining popularity among urologists and now is the most common technique performed for prostate cancer surgery. The surgeon sits at a console with a 3-D monitor and two joysticks. Movements by the surgeon's hand or wrist are translated into precise movements of the surgical instruments.

Following medical school, surgeons undergo training while serving as residents, and some surgeons undergo additional training as fellows. However, there is no standardized training in robotic surgery for residents and fellows and few guidelines for determining competency.

The Accreditation Council for Graduate Medical Education's logging system for robotic surgeries is the same as that used for other types of surgery: A resident either performed the surgery or acted as an assistant. But this system does not accurately reflect a trainee's actual robotic experience because there is considerable variation in how much a resident participates on the console. For example, a resident who performs only one part of a robotic prostate cancer surgery – removing the lymph nodes – will get the same credit as a resident who performs the surgery from start to finish.

RoboLog is a web-based program that provides much more detailed information about a resident's involvement in robotic surgeries. The system includes 11 common urologic robotic procedures. For each surgery recorded, there's a drop-down menu listing the steps of the surgery. The resident checks each step that he or she performed, and how many minutes it took to perform each of the key steps. No patient identifying information is included. Residents who have little experience in certain surgical steps can be identified early and this deficit can be addressed.

The median time for a resident to log a case was 59 seconds and the median time for a supervising surgeon to review it was 53.5 seconds.

Two other centers have begun using RoboLog and Loyola plans to make the system available to any program that wishes to use it.

"Widespread usage of a logging system with more insight into step-specific involvement is needed," researchers concluded. "RoboLog fills this need and can be used to track robotic training progress and aid in development of a standardized curriculum."

The study is titled, "Design and implementation of a robotic surgery training experience logging system."

In addition to Drs. Baldea and Gupta, other co-authors are Ryan Thorwarth, Petar Bajic, MD, and Marcus Quek, MD.

Screenshot of a surgeon logging a robotic prostate cancer surgery in RoboLog.

Screenshot of a surgeon logging a robotic prostate cancer surgery in RoboLog.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.