The growing role of robotic surgery in gynecology at Winnie Palmer Hospital for Women & Babies

Lately there has been some very serious discussion in the media about robotic surgery programs, how surgeons are credentialed and trained, and the role that the manufacturer of the robotic equipment (Intuitive Surgical) may or may not play.

I would like to take a few moments to discuss the Minimally Invasive Surgery (MIS) Program at Winnie Palmer Hospital. Inclusive in the definition of minimally invasive surgery are procedures performed either vaginally, laparoscopically or with robotic assistance. We believe the outcomes of these procedures, as well as the skills it takes to do them, are so important we have an entire committee dedicated to the evaluation of our MIS Program, procedural outcomes and the physicians performing them. This committee is comprised of robotic surgeons, laparoscopic surgeons, anesthesiologists and surgical nurses who evaluate each case and surgeon. The MIS Program is run solely by our staff in cooperation with the companies that have developed minimally invasive technologies. The training of our surgeons and staff about the technology and how to use it safely is critical. However, we never use manufacturers or their representatives in the development of our quality parameters, protocols, credentialing surgeons, or patient selection.

How do our surgeons become robotic surgeons?

Surgeons who show interest in robotics are first asked to shadow a seasoned robotics surgeon for several cases, and if they are still interested they attend a robotics training course. After they attend the course they are asked to schedule their first robotics case within two weeks of the course. The first 3-5 cases are proctored (overseen) by a seasoned surgeon and some surgeons have had as many as 8 proctored cases. Each case is evaluated and the proctor discusses procedural tips with the surgeon. Our surgeon may not schedule an unproctored case until the proctor has signed off that the surgeon has demonstrated safety with the use of the robot, understands what kinds of patients are appropriate for a minimally invasive approach, and is confident they do enough surgery to maintain their skills. The surgeon is also required to do their proctored cases within three months, and if they haven't they need to be re-proctored.

The minimally invasive surgery committee reviews the first 20 cases performed by every new robotics surgeon and provides a written review. If there are issues, these are specifically addressed with the surgeon. When robotic surgeons want to pursue more advanced cases beyond the scope of what they currently do, they are asked to observe an expert who performs that particular surgery first and then to have 3-5 cases proctored by that expert.

A growing field

Our Program has 24 robotically trained surgeons out of 120 obstetrician/gynecologists who practice at Winnie Palmer Hospital. We are very proud of our quality protocols, our high standards for safety, and our excellent outcomes. We promote camaraderie among the surgeons, and this has opened up conversations between professionals who are excellent at what they do. This conversation alone has helped surgeons develop different techniques to improve their outcomes. Every procedure done in a minimally invasive manner at Winnie Palmer Hospital is evaluated, and we follow strict quality guidelines for everyone no matter the experience.

We are committed to the safety of our patients in our communities throughout Central Florida. We have set high standards of excellence for our programs in women’s health and our great patient outcomes validate the effort we make every day at Winnie Palmer Hospital to deliver a high-quality yet personal healthcare service for women of all ages.