A. M. Al-Ayoubi1, C. M. Forleiter3, M. Barsky1, A. Bogis1, S. Rehmani1, S. Belsley3, R. Flores2, F. Y. Bhora1 1Mount Sinai School Of Medicine,Mount Sinai Roosevelt Hospital/Department Of Thoracic Surgery,New York, NY, USA 2Mount Sinai School Of Medicine,Mount Sinai Hospital/Department Of Thoracic Surgery,New York, NY, USA 3Mount Sinai School Of Medicine,Mount Sinai Roosevelt Hospital/Department Of Surgery,New York, NY, USA
Introduction: The recent surge of robotic-assisted surgery necessitates effective guidelines to ensure safe outcomes. We provide a stepwise algorithm for granting privileges and credentials in robotic-assisted surgery. This algorithm reflects increasing level of responsibility and complexity of the surgical procedures performed. Furthermore, it takes into account volume, outcomes, surgeon's proficiency and appropriateness of robotic usage.
Methods: We performed a literature review for available strategies to grant privileges and credentials for robotic usage. The following terms were queried: robot, robotic, surgery and credentialing. We provide this algorithm based on review of the literature, our institutional experience, as well as the experience of other medical centers around the US.
Results:
46 manuscripts were identified in the published English language literature through August 2014. Two pathways for robotic training exist: residency- and non-residency-trained. In the US, JCAHO requires hospitals to credential and privilege physicians on their medical staff. Table 1 shows our algorithm for granting robotic privileges in a graduated fashion. A credentialing designee (CD) oversees and reviews all requests. Residency trained surgeons must fulfill 20 cases with program directors’ attestation to obtain Full privileges. Non-residency trained surgeons are required to fulfill the following: simulation, didactics including online modules, wet labs (cadaver or animal) and observation of at least 2 cases for Provisional privileges.
To serve as a proctor, a surgeon with Full privileges must complete 25 cases in the same specialty with good outcomes and be approved by the CD and the chair. A minimum number of cases (10) is required to maintain privileges. Cases are monitored via departmental QA/QI committee review. Investigational uses of the robot require IRB approval. Complex operations may require additional proctoring and QA/QI review.
Conclusion: Safety concerns with the introduction of novel and complex technologies such as robotic-assisted surgery must be paramount. Our algorithm takes into consideration appropriate utilization, restraint of trade and state reporting ramifications. Furthermore, it serves as a basic guideline for institutions that wish to implement a robotic-assisted surgery program.
