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Robotic Mitral Valve Surgery Manual
Alison Ranade, MS PA -C, Bob Kiaii, MD, Sarah Chen, MD, Nataliya Bahatyrevich, MD, Kimberly Smith, MS PA-C;
UC Davis Medical Center, Sacramento, CA, USA
OBJECTIVES: The learning curve for minimally invasive mitral surgery is steep due to the complexity of steps required for the operation and intricate coordination and communication required between the console surgeon and the bedside assistant. From the point of view of the bedside assistant, utilizing an established manual can markedly streamline the onboarding process for those learning to be a bedside assistant. Here, we outline the experience at our institution to describe the impact of an advanced practice provider training manual and how it affects overall surgical case efficiency including decreased cross-clamp and improved patient safety/outcomes. METHODS: Our institution set up 33 simulation sessions totaling 83 hours of training, including classroom style education and online modules to review the history and technology of the Da Vinci Xi robot, hands-on docking/instrument exchange, atriotomy, chordoplasty, valvuloplasty, annuloplasty, and atriotomy closure with the use of a LifeLike Bio Tissue model. A guidebook was created at the conclusion of the simulation sessions, which was serially edited throughout subsequent live cases. This guidebook details the care of a patient from the patient selection process (relative/absolute contraindications), analysis of ECHO to determine size of neo chords, pre-operative work-up including appropriate labs/diagnostics, operating room checklist, and establishing a quick guide for major steps of the operation. RESULTS: This guidebook was passed along to bedside assistants in-training and was updated in real time with each subsequent case debriefing session. This manual ultimately contributed to helping reduce operative times, as it gave a framework for the bedside assistant team to quickly and efficiently integrate into their role with the console surgeon. Cross-clamp times overall decreased after our first 10 cases and continued to decrease when the same surgical team was used due to repetition and collaboration of steps. CONCLUSIONS: The creation of a guidebook detailing the critical steps of the operation was critical to ensure that no important steps of the operation were overlooked. This process led to an improvement in cross-clamp times and efficiency of the staff training and operation flow. We are hopeful to utilize this manual to assist other hospitals when starting a new robotic program.
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