RATS Masterclass - New Technologies and NoTech Processes for Security and Performance

This practical course will help you discover the latest technological advances in robotic surgery for the management of lung cancer and mediastinal lesion.

We will focus on two main aspects of the Robotic Platform: the technical part which is mandatory but not sufficient; and the second part will emphasize the role of human factors and the team to perform safe and efficient procedures.

Technical aspects:

• Da Vinci X surgical system, Intuitive
• 4-Arm Standardised lung resection
• Image assisted using Visible Patient® 3D reconstruction in conjunction with Tile Pro (Intuitive) mode on the X system
• Firefly infrared technology
• SureForm
• Different Energy modalities
• Different Stapling Strategies (SureForm, Intuitive, ECHELON FLEX^TM Powered Vascular Stapler, Ethicon, Signi Stapler Medtronic)
• Capnothorax using Airseal®, Conmed

Non-technical Aspects:

• Human factors
• Cognitive tools (Robotic check-list, Crisis Check-list)
• Team Training
• Stress Management
• Crisis Resource Management (CRM) using multidisciplinary team simulation
• ERAS pathway: from surgical education to early rehabilitation

One of the problems of minimal invasive thoracic surgery is major intraoperative complications, especially in RATS. To address this safety concern, we started developing new tools 5 years ago with the aim of improving operative safety and using a multidisciplinary approach.

One of the main aspects of preventing and managing major complications is based on simulation with team resource management, acute stress management and the development of non-technical skills.

This course will draw on the expertise of different specialists: an anesthesiologist, a radiologist, a human factor expert from aviation, a psychologist, a specialist in communication and of course a thoracic surgeon.

Thoracic Surgeons

Technical Aspects - references

• https://www.ncbi.nlm.nih.gov/pmc/?term=baste+jm+robotic
• https://www.ctsnet.org/home/jmbaste
• https://www.ircad.fr/training-center/course-calendar/?id=1054&utm_source=websurg&utm_campaign=websurg-media
• https://www.bing.com/search?q=websurg+baste+jm&cvid=3b993e602bbe46a7ba326a123633b483&FORM=ANAB01&PC=U531

Non-Technical Aspects - references

• Rinieri, P., Selim, J., Le Guillou, V., & Baste, J. M. (2020). Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report. Journal of cardiothoracic surgery, 15(1), 173.
• Jean-Marc Baste.et al Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance? JTD 2020 doi: 10.21037/jtd-2020-epts-03
• Letter From the Guest Editor: Nontechnical Skills in Cardiothoracic Surgery

Thursday June 10th

13:00 Lunch

14:00 Opening Session

14:15 General Introduction - New context in Surgical Safety and Performance in the era of Robotic Surgery

Non-Tech Skills and Tool kits for team training and working: (Human factors, crisis management, team training, Crew resource management, enhanced performances, check list, stress (JM Baste)

14:30 Operative Safety, The anesthesiologist’s point of view (J Selim)

14:50 Operative Safety, the Surgeon point of view: Cognitive simulation(3D), Cognitive tools (check lists, 3D reconstructions…) (JM Baste)

15:30 Acute stress management and performance during operative complications (JM Coq)

16:00 Human Factors and Operative Room Audit (STAN Institute)

16:30 Briefing In Situ Simulation - Team Training: Objectives

17:00 Scenario of Robotic RUL with the whole team and all the different surgical steps. Uncontrolled bleeding or major desaturation? Crisis management (JM Baste – A Lefevre)

17:45 Debriefing: Surgeon, anesthesiologist, consultants, participants (evaluation scale for NOTS, stress management) STAN Institute will lead the debriefing

18:45 End of the session

Friday June 11th

7:45 Opening

8:00 Robotic 4-arm technique for lung resection (JM Baste)

8:40 Presentation of pre-operative marking using virtual bronchoscopy and Radial EBUS (by videoconference in theatre) (S Lachkar)

9:00 Live Case Robotic-assisted Segmentectomy with operative planning and operative assisting using 3D model (Visible Patient, Therapixel)

11:30 Presentation of the ERAS Pathway (F Boujibar)

12:30 Lunch

13:00 Live Case of Robotic-assisted lobectomy with Da Vinci X surgical system and SureForm

16:00 General debriefing focusing on the technical and non-technical parts of this course

17:00 End of the session