OGC SO16 - International upper GI robotic fellowship on the CMR Versius platform

Abstract Background The impetus for UGI surgery trainees to attain skills in robotic surgery is likely to increase following the global acceptance and utilisation of robotic platforms. UGI robotic fellowship programs are few in number and highly desirable providing trainees with a unique selling point when embarking on independent consultant practice. We describe the first UGI robotic surgery fellowship on the CMR Versius platform at the Gloucestershire Royal Hospital which has the largest experience of UGI robotic surgery on the CMR Versius platform in the UK, having performed over 200 cases including the first robot assisted minimally invasive oesophagectomy. Method A structured robotic training curriculum was created in collaboration with CMR Versius. It consists of a pre-clinical phase of E-learning (10 modules), simulator training (16 assessed tasks) and dry-laboratory training (a two-day course encompassing robotic system set-up, bed-side assist and assessed dry lab practical tasks). The clinical phase begins with bed-side assisting of robotic cases followed by supervised operating on the console. Operations performed on the console are recorded for review and evaluation. The videos will be scored by two independent surgeons using the modified Global Evaluation Assessment of Robotic Skills (mGEARS) score to track growth and progress. Results The E-learning modules and assessments were completed prior to commencement of the fellowship. The remainder of the pre-clinical phase of the curriculum were completed within 4 weeks of commencement followed by bed-side assisting. Once competent at bed-side assisting and able to demonstrate proficiency in set-up (selecting port site placement, docking, arm spacing and configuration), supervised console training was commenced 6 weeks into the fellowship. Console training began with robotic assisted laparoscopic assisted cholecystectomy to gain familiarity, confidence, and efficiency. After 6 cases as the only console surgeon, the surgical complexity of cases was progressed to hiatal surgery and Heller’s cardiomyotomy Conclusion A structured training curriculum with defined phases provides a feasible and effective framework for robotic fellowship training. Adherence to the pre-clinical phase of training allows safe and efficient progression to hands-on console experience. This is achievable within relatively short timeframe to allow for ample independent console surgeon experience and the development of proficiency within a 12-month fellowship period.