As the prevalence of robotic assisted surgery has grown exponentially over the last 2 decades, there has been an opportunity to improve surgical quality utilizing surgical rehearsal and telementoring. The robotic platform lends itself very well to simulation and telementoring. This was not lost with the early developers of the da Vinci®. Even as the da Vinci was in its earliest stages of development, virtual reality simulation development was occurring simultaneously.¹ We explored the utility of surgical warm-up and found that surgeon performances on the da Vinci platform could be improved with a brief warm-up on a virtual reality simulator.² There are multiple validated curricula for simulation in robotic assisted surgery, but the Fundamentals of Robotic Surgery curriculum has undergone more rigorous testing than most.³

Even as the robotic surgical platform was in development for applications in military medicine, telepresence for mentoring was one of the key development requirements.⁴ The concept was that a surgical specialist at a fixed facility could advise the surgeon working in a remote and austere environment (fig. 1). Because of the videoscopic view with the robotic approach, this platform lends itself very well to telementoring. Further work has been done to expand the telementoring technology beyond 2-dimensional telestration using 3D “ghost” tools with 3D Instruments and 3D Hands.⁵ A recent white paper published by the American Urological Association explores opportunities in telesurgery.⁶ Some of the challenges associated with telementoring include financing, medicolegal considerations and cybersecurity.⁷

Figure 1. Remote supervision of surgery in an austere environment. Reprinted with permission of the Journal of The Society of Laparoscopic & Robotic Surgeons and The Society of Laparoscopic & Robotic Surgeons.⁴

Figure 2. Advanced 3D imaging for presurgical planning and intraoperative use. Reprinted with permission of Intuitive Surgical, Inc.

Patient-specific simulation opportunities have been considered to be the “Holy Grail” of surgical simulation. One of the greatest advancements to that end has been using 3D printing to generate models for simulation events.⁸ Additionally, 3D reconstruction of imaging can be used at the surgeon console before and during a robotic surgical case using the Iris service from Intuitive. This augmented reality platform uses imaging to enhance presurgical planning (fig. 2).⁹

There have been too many times in our profession and in others where technological development and adoption of enhanced surgical techniques has outpaced the development of the educational and training opportunities that may improve safety and quality. We, as surgeons and educators, in collaboration with our industry partners and government funding agencies, must help ensure that adequate time and resources are devoted towards the development of training and simulation platforms that may accompany the adoption of these new technological developments. Robotic assisted surgery has been a great case study for this, and the opportunity for enhanced quality and safety through surgical rehearsal and telementoring continues to grow and develop.