Rachelle Bissett-Amess, Coordinator of EARCS
Rachelle is the Coordinator of EARCS (European Academy of Robotic Colorectal Surgery), a professional training body for qualified robotic colorectal surgeons, founded in 2014.
In June 2014, there was a consensus meeting here at the Champalimaud Foundation, focusing on the growing popularity of robotic surgery, particularly for rectal cancer. The meeting resulted in the creation of a professional training body - the European Academy of Robotic Colorectal Surgery (EARCS) – to meet the demand for qualified robotic colorectal surgeons. EARCS was founded in October 2014 with Prof. R. J. (Bill) Heald as Honorary Chair, Prof. Amjad Parvaiz and Prof. Giuseppe Spinoglio as the founding Directors, and participating faculty as the founding members. Since February 2015, when the Academy became fully operational, Rachelle Bissett-Amess has been Project Coordinator of EARCS and she joined us recently to talk about exciting developments in this ground-breaking endeavour.
Good morning, Rachelle. Let’s start at the beginning; how did you find yourself here at the Champalimaud Foundation?
Hi! It’s a long way from Australia to here, and a long story, too! Basically, I have a background in environmental chemistry, which may seem a long way from my current position, but my previous work also involved Project Management – just in a different field.
I was adamant that I wanted to work in a place that I could believe in; where I could contribute positively to the world around me. That is certainly true of the Champalimaud Foundation. I am surrounded by some of the most intelligent, creative people – people at the top of their respective fields in a truly international environment. Prof. Bill Heald is the Godfather of TME [Total Mesorectal Excision] surgery and Prof. Amjad Parvaiz is considered by many to be the best robotic surgeon on the planet so it’s a real privilege to work with such luminaries. There have been challenges along the way, of course, but so far so good!
Could you tell us a little more about the European Academy of Robotic Colorectal Surgery?
Sure. EARCS operates out of the Foundation, but training is conducted all over Europe at the more than 80 hospital sites of our training delegates and faculty. EARCS is externally funded by Intuitive Surgical, although all of the data we collect and information we process is completely independent. The Academy has two functions: first and foremost, to train colorectal surgeons to perform robotic colon and rectal resection (tumour removal surgery), and to collect data from robotic colorectal surgeries for research.
Let me explain the second point first: in terms of research, we collect data from surgeries performed by our delegates and our faculty to build up a registry. We will use this to publish information on things like how long the surgery takes, how long it takes the patient to recover etc., so that we can determine things like the learning curve of a particular surgeon or analyse the oncological outcomes of performing such surgery robotically.
More importantly though, EARCS is the first comprehensively structured training academy for robotic surgery in the world, and right now is a very exciting time for this side of our work. We have just seen our first group of six delegates successfully completing the course, we have 18 more going through final assessment and a further 45 undergoing training. It is a comprehensive and rigorous programme that results in the surgeons being ‘certified’ by the Academy upon completion.
Congratulations, to you and them! How does the course work?
Our European faculty of 21 superstar robotic colorectal surgeons have developed a process of delivering standardised training to our delegates so they can become proficient and independent in performing colon and rectal surgery robotically. There are essentially three components of the training and delegates are expected to pass an assessment to progress to the next step. First, the delegates will attend lectures and observe a live case at the hospital of one of our faculty. Second, the delegates will attend a designated training centre to learn how to use the robotic system and apply it to surgical procedures. The last, and most intense part of the training, is hands on clinical training at the delegates own hospital. Over several weeks, the delegates perform a number of cases under their direct supervision of one of our faculty (we call them “proctors”). After completing the required number of cases and at the discretion of the proctor conducting the training, delegates are required to submit two video recordings of self-performed (unaided) robotic colorectal surgery (one colon and one rectal tumour removal or “resection”). These videos are then evaluated in a blind test by two of our faculty before the delegate can graduate from the Academy. The course is designed to take around 16 weeks, but the actual time depends upon the schedules of the surgeons involved.
Currently, our faculty members are training 69 delegates in 13 different European countries, and have performed around 200 training cases so far. They are a very dedicated group of people!
"Training colorectal surgeons to support the growing interest in robotic surgery, particularly for rectal resection, is a critical step towards ensuring that health care providers are successful in their adoption and meaningful use of the latest techniques for minimally invasive surgery. The EARCS training programme delivers a comprehensive approach to address the needs of colorectal surgeons wising to adopt robotic surgical systems. The Academy is designed to deliver competent professionals who are proficient in all facets of robotic colorectal surgery."- Prof. Amjad Parvaiz, Co-Director of EARCS and Head of Minimal Access and Robotic Colorectal Surgery here at the Champalimaud Foundation
How exactly do you learn how to operate this equipment?
It is slightly different depending on the facilities available at the hospital in question, but the idea is always the same. Here, at the Champalimaud Foundation, there are two consoles in the training room that the surgeons sit in front of, with 3-D vision, controlling the ‘robot’. One of the consoles will be operated by Prof. Parvaiz, the other by the delegate surgeon. At the beginning, the surgeon will simply watch as Prof. Parvaiz demonstrates the controls and the techniques involved. Then, over time, Prof. Parvaiz will give more of the responsibility to the delegate surgeon, whilst constantly remaining on hand, in case assistance becomes necessary. It is very much like learning to drive, actually, with the instructor sitting next to you, ready to take the wheel at a moment’s notice!
I notice that you referred to the equipment as a ‘robot’…
I don’t like that term, actually, but it is what most people use when they refer to the equipment. I think it gives the wrong idea of some autonomous ‘mechanoid’, programmed to operate independently! The truth is, when a patient is operated on robotically, the surgeon is right next to them, in the same room, in full control of every movement. The ‘robot’ is just another tool at the surgeon’s disposal, and it certainly doesn’t operate by itself. The surgeons are, of course, completely capable of removing the ‘robot’ instantly if necessary in order to complete the surgery using laparoscopic or open surgery techniques.
In the Academy, our surgeons are trained using the Intuitive robotic da Vinci® Surgical System, which some of us refer to as “Leo” (as in Leonardo da Vinci). The equipment enables surgeons to perform delicate and complex operations through a few small incisions and consists of several key components: an ergonomically designed console where the surgeon sits comfortably while operating, a patient-side cart where the patient is positioned during surgery, interactive robotic arms, a 3D HD vision system, and specialised instruments. It is powered by state-of-the-art robotic technology that allows the surgeon’s hand movements to be scaled, filtered and translated into precise movements of the instruments working inside the patient’s body.
If the surgeon can use all of these different techniques, what are the advantages of robotic surgery?
When we talk about Minimally Invasive Surgery (MIS) techniques, most people think of laparoscopy, which has become the gold standard for the treatment of colorectal cancer:
“Laparoscopic surgery is associated with better short-term outcomes, such as less postoperative pain, less blood loss, reduced analgesia requirement and shorter hospital stay. Whilst laparoscopic colonic surgery is relatively easy to perform with minimal impact on oncological outcomes, laparoscopic rectal cancer surgery is associated with higher morbidity and higher rates of conversion to open surgery. Pelvic surgery for rectal cancer presents the technical problems of bony confines, access and exposure issues, that makes this surgery technically very challenging. With a robotic surgical system, some of these technical issues of exposure, access and wrist manipulation can be overcome.” - Prof. Amjad Parvaiz
Clearly, having 3-D visualisation of the operating field is also a huge advantage. And something that is not to be underestimated is the comfort of the surgeon – laparoscopic surgery can involve the surgeon maintaining uncomfortable positions for hours at a time.
But as I said, while the advantages of robotic surgery are there for anybody to see, it is still just another tool for the surgeons to use – it does not replace the highly skilled professionals that we are training through our work here with EARCS.