Richard Satava

• University of Washington

Large language models (LLMs) have the intrinsic potential to acquire medical knowledge. Several studies assessing LLMs on medical examinations have been published. However, there is no reported evidence on tests related to robot-assisted surgery. The aims of this study were to perform the first systematic review of LLMs on medical examinations and...

BACKGROUND Large language models are capable of answering questions as if they were engaged in active conversation with users. However, currently, there are no data on whether their performances will remain static or vary over time when answering questions in the medical domain. OBJECTIVE The aim of the present study was to assess ChatGPT and Inst...

Robotic surgery has revolutionized surgery over the last two decades. The coalescence of numerous past events across different sectors led to the creation of the robotic surgical systems used today. In this chapter, you will see the timeline, through the decades, of the development of robotics in the different specialties of surgery, such as orthop...

Technology is a major driver of the revolutionary changes in surgery, with robotic-assisted minimally invasive surgery (RAMIS) being one of the latest major additions to surgical practice. Not only is new curriculum development for training and assessment needed, but certification, credentials, and privileging are required. New methodologies for tr...

Background The literature on artificial intelligence (AI) in surgery has advanced rapidly during the past few years. However, the published studies on AI are mostly reported by computer scientists using their own jargon which is unfamiliar to surgeons. Methods A literature search was conducted in using PubMed following the preferred reporting item...

Worldwide up to May 2022 there have been 515 million cases of COVID-19 infection and over 6 million deaths. The World Health Organization estimated that 115,000 healthcare workers died from COVID-19 from January 2020 to May 2021. This toll on human lives prompted this review on 5G based networking primarily on major components of healthcare deliver...

Background Despite the extensive published literature on the significant potential of artificial intelligence (AI) there are no reports on its efficacy in improving patient safety in robot-assisted surgery (RAS). The purposes of this work are to systematically review the published literature on AI in RAS, and to identify and discuss current limitat...

Background: Most healthcare providers are unaware of the extraordinary opportunities for implementation in healthcare which can be enabled by 5G wireless networks. 5G created enormous opportunities for a myriad of new technologies, resulting in an integrated through 5G 'ecosystem'. Although the new opportunities in healthcare are immense, medicine...

Fundamentals of robotic surgery (FRS) is a proficiency-based progression curriculum developed by robotic surgery experts from multiple specialty areas to address gaps in existing robotic surgery training curricula. The RobotiX Mentor is a virtual reality training platform for robotic surgery. Our aims were to determine if robotic surgery novices wo...

Background and objectives: In 2016 we published a stepwise evidence-based model (subsequently named SimSteps) for curriculum development (CD) of simulation-based courses. The current study aimed to assess the uses, user friendliness, and perceived effectiveness of this model and its worksheet and to obtain suggestions for improvement. Methods: W...

To improve patient outcomes in robotic surgery, robotic training and education need to be modernised and augmented. The skills and performance levels of trainees need to be objectively assessed before they operate on real patients. The main goal of the first Orsi Consensus Meeting on European Robotic Training (OCERT) was to establish the opinions o...

Objective To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. Summary Background Data There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. Methods Single-blinded parallel-group ran...

By defining the current status of simulation, we are able to project a reasonable estimation of the next generation in simulation. There are few new methodologies that leverage off nonmedical simulation to develop curricula which provide quantitative assessment of skills performance and to set benchmarks for performance which must be met: full life...

Background Training in medicine must move to an outcome‐based approach. A proficiency‐based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency. Methods In st...

The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic sur...

Despite the rapid growth in the use of simulation in health professions education, courses vary considerably in quality. Many do not integrate efficiently into an overall school/program curriculum or conform to academic accreditation requirements. Moreover, some of the guidelines for simulation design are specialty specific. We designed a model tha...

There is a need for a standardized curriculum for training and assessment of robotic surgeons to proficiency, followed by high-stakes testing (HST) for certification. To standardize the curriculum and certification of robotic surgeons, a series of consensus conferences attended by 14 leading international surgical societies have been used to compil...

form only given. Virtual reality has gone from research to educational tool to indispensible clinical application in patient care. A brief review of the current status of the use of VR in medicine will provide the springboard for the current gaps that provide future opportunities in simulation as well as an introduction to new advanced technologies...

The toxicity associated with concomitant chemoradiation for the management of laryngeal and pharyngeal carcinoma has been well documented. Minimally invasive surgical techniques offer the potential to extirpate the malignancy as a single-modality therapy and provide essential information that may direct subsequent treatment. In selected patients, r...

Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the...

To examine the effect of previous-day excessive alcohol consumption on laparoscopic surgical performance. Study 1 was a randomized controlled trial. Study 2 was a cohort study. Surgical skills laboratory. Sixteen science students (laparoscopic novices) participated in study 1. Eight laparoscopic experts participated in study 2. All participants wer...

The first major revolution in surgery since the origins of surgery as we know it today (the Golden Era of Surgery in the late 1800s) occurred approximately 100 years after the seminal changes in medicine: Laparoscopic surgery was “born” in the late 1980s to early 1990s. This was a painful “birth,” with an unfettered enthusiasm to begin new procedur...

Laura Sigismund Leddy, Thomas S Lendvay, Richard M SatavaDepartment of Urology, University of Washington, Seattle, WA, USAAbstract: Robotic surgery has been embraced by many surgical specialties and is being incorporated into an ever growing number of surgical procedures within those specialties. The outcomes and cost data that are available varies...

For the first time in over 100 years, there is a revolution in surgical education. One of the most important core technologies generating this revolution is simulation science, which includes not only the technology of simulators but new curricula, objective assessment methods, and criterion-based requirements. By reviewing the current status of si...

Minimal access surgery is associated with increased risk of complications, particularly early in a surgeon's laparoscopic career. This is mostly due to loss of depth cues, degraded tactile feedback from surgical instrument, and the "fulcrum effect". Degraded and restricted image on the monitor makes camera orientation very important. The objective...

The last major change in medical education was the Flexner Report, over a century ago. Since that time, iterative improvements have occurred to the question-and-answer and "see one, do one, teach one" educational environment. However, multiple external forces-from the 80-hour work week to the emphasis on patient safety to competing demands on stude...

Since the advent of minimally invasive surgery, there have been new discoveries in robotics to perform telesurgery, in virtual reality and surgical simulators for surgical education and many emerging new technologies to revolutionize what the future of surgery will become. This is a review of the state of the art in these related fields, of disrupt...

Summary The field of minimally invasive surgery has created a demand for a new way to train surgeons. The skills required are very different from those developed performing open surgery, and the costs of training with humans are prohibitive. Virtual reality offers a potential solution to the limitations of a surgical simulator. Although presently i...

The Trauma Pod (TP) vision is to develop a rapidly deployable robotic system to perform critical acute stabilization and/or surgical procedures, autonomously or in a teleoperative mode, on wounded soldiers in the battlefield who might otherwise die before treatment in a combat hospital could be provided. In the first phase of a project pursuing thi...

Surgery is a skill-driven discipline. While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency, the effects of such practice have not been investigated sufficiently in surgical tasks. Subjects performed standardized exercises as a preoperative warm-u...

Health-care system reforms can change the structure of the current U.S. health-care system, from centralized large hospitals to a distributed, networked healthcare system. In our model, medical care is delivered locally in neighborhoods and individual homes, using computer technologies like telemedicine, to link patients and primary care providers...

Technology has become a major driver of the future direction of healthcare and surgery. Likewise, the speed of change has accelerated beyond comprehension, with a number of revolutions occurring during a surgeon's career. Being an agent of change or rapidly adapting to change has become the hallmark of the gifted surgeon. The fundamental challenges...

Although simulation is relatively new to surgical education, there is a long history in many other disciplines, such as military, aviation, and nuclear power plant operations, among others. In the late 1980s these technologies began to be adapted to the surgical world, along with the new technology of virtual reality. This is a review of the introd...

In our effort to establish criterion-based skills training for surgeons, we assessed the performance of 17 experienced laparoscopic surgeons on basic technical surgical skills recorded electronically in 26 modules selected in 5 commercially available, computer-based simulators. Performance data were derived from selected surgeons randomly assigned...

With patient safety and improved outcomes as its focus, the Institute for Surgical and Interventional Simulation (ISIS), is dedicated to the training of medical professionals in technical and procedural skills, and research and development of emerging simulation technologies and educational strategies. ISIS is a collaborative institute of the Unive...

To establish discriminant validity of the endoscopic sinus surgery simulator (ES3) (Lockheed Martin, Akron, Ohio) between various health care provider experience levels and to define benchmarking criteria for skills assessment. Prospective multi-institutional comparison study. University-based tertiary care institution. Ten expert otolaryngologists...

Surgery has just passed through the laparoscopic surgery revolution, with validation of the advantages for the patient evaluated painstakingly; however, laparoscopy is a transition phase to fully information-based surgery, which only can be accomplished when hand motions are converted to information through robotic surgery systems. The main advanta...

With the rapid acceleration of technology, fundamental changes in the science of surgery are emerging within the lifetime of a surgeon's practice. This review includes the technologies of information systems, robotics, virtual reality, simulation and training, directed-energy surgical instruments, photonics, and brain chips, as well as their impact...

Errors and "patient safety" have taken on monumental importance for surgery. Like all things new, there is an initial over-reaction before a return to a balanced perspective. The current response to the global interest in error has been to seize on the latest reports that are focusing on the "systemic nature" of errors, which is also being referred...

The scientific method has been the mainstay of scientific inquiry and clinical practice for nearly a century. A new methodology has been emerging from the scientific (nonmedical) community: the introduction of modeling and simulation as an integral part of the scientific process. Thus, after the hypothesis is proposed and an experiment is designed,...

Because so much has been discovered during the intervening century since the publication of Nicholas Senn's historic article, especially with the extraordinary acceleration of technology in the latter ha of the 20th century, focus will be on the same areas addressed by Nicholas Senn to provide a sense of the incredible progress that has occurred an...

To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solutio...

Summary background data: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgic...

In recent years, the question of medical errors has received increasing attention. To minimize or avoid errors, it is important to understand both the error itself and the factors leading up to it, as well as the type of error that has been committed. Simulators, which have gained increasing importance in surgical training, can also be useful to "t...

The training of a surgeon includes the acquisition of a number of characteristics. These include a cognitive knowledge base, problem formulation and decisionmaking abilities, appropriate psychosocial relationships, and other attributes that can be measured with objective testing, such as national board or specialty certifying examinations. Perhaps...

We examined the face, content and construct validity of version 1.0 of the University of Washington transurethral prostate resection (TURP) trainer. Version 1.0 of a virtual reality based simulator for transurethral skills was developed at our laboratory by integrating TURP hardware with our virtual 3-dimensional anatomy, irrigation control, cuttin...

The training of residents in otolaryngology and, indeed, in all surgical fields, is predicated on acquiring a number of skills. One of the most critical of these is technical capability—essentially, the ability to perform the operations intrinsic to the specialty. This skill is at the core of surgery and without it the trainee cannot and should not...

The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills-which are at the core of the profession-are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without r...

The foundations of surgery have rested upon the passing of knowledge from generation to generation by mentors and manuscripts. Until the 1900 s, the passage of knowledge was through tradition. Since then, it has changed from observation and experience to the scientific method to clinical trials. A new approach, derived from other scientific discipl...

Beyond current laparoscopic surgery is the emergence of robotic surgery. The power of this type of surgery is converting both vision and hand motions into electronic signals (video and telemanipulation), which completes the transition of surgery from the Industrial Age to the Information Age. Other advances include replacing scrub and circulation n...

Technological change, decreased financial support for medical education, and social oversight (in the form of the "To Err Is Human" report, HIPPA, and reduced work hours) are forcing a rethinking of the traditional model of surgical education to improve patient safety. New approaches to evaluating surgical competence, such as objective assessment,...

The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis. After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the...

The discipline of surgery has become even more complex with the rapid introduction of revolutionary technologies. Laparoscopic surgery is just the simplest and first of these new directions. Robotic surgery and image-guided therapy are the next generation. As biosurgery and other modalities are introduced, the complexity will increase exponentially...

Increasing constraints on the time and resources needed to train surgeons have led to a new emphasis on finding innovative ways to teach surgical skills outside the operating room. Virtual reality training has been proposed as a method to both instruct surgical students and evaluate the psychomotor components of minimally invasive surgery ex vivo....

Telesurgical mentoring has evolved as an important subset of telemedicine, yet has remained an underutilized technique when all its potential is considered. As applied to surgery, telementoring is used when an experienced surgeon assists or directs another less experienced surgeon who is operating at a distance. Two- and three-dimensional, video-ba...

A review of the history of robotic surgery--from its beginnings in a collaboration of engineers, computer scientists, and a plastic surgeon from Stanford Research Institute (SRI) and the NASA-Ames Research Center to the next generation of systems on the drawing board in the Department of Defense--provides a rich and colorful look at the author's pa...

The incorporation of new devices into surgical practice often requires that surgeons acquire and master new skills. We studied the learning curve for intracorporeal knot tying in robotic surgery. We developed an objective scoring system to evaluate knot tying and tested eight attending surgeons during 3 weeks of training on a surgical robot. Each p...

There are a number of new therapeutic options generated by the biotechnology, bioengineering, and bioimaging revolutions in terms of organ-specific designer drugs, genetically engineered cells, cell-specific proteins and drugs, directed energy instruments, therapeutic microdevices, etc. Many of these new therapies need to be placed exactly on, with...

The development of reliable behavioral assessment tools and validated education and training strategies are relatively new to surgery but not to science. On encountering studies that claim to report on validation and reliability efforts of training and assessment strategies the surgical community is advised to interpret these claims with caution. S...

Technology is rampant, exponentially growing beyond the bounds normally comprehensible by the human mind. Many of these technologies are so fundamentally disruptive that they challenge the very practice of science. Discoveries once unimaginable except in science fiction are appearing at such a rapid rate that there is no time to evaluate their mora...

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare....

Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a surgeon to acquire and master. Although assessment technologies have been proposed, precise and objective psychomotor skills assessment of surgeons performing laparoscopic procedures has not been detailed. Two hundred ten surgeons attending the 2001 ann...

Laparoscopic surgery requires surgeons to infer the shape of 3-D structures, such as the internal organs of patients, from 2-D displays on a video monitor. Recent evidence indicates that the issue is not resolved by the use of contemporary 3-D camera systems. It is therefore crucial to find ways of measuring differences in aptitude for recovering 3...

Technology is rampant, exponentially growing beyond the bounds normally comprehensible by the human mind. Many of these technologies are so fundamentally disruptive that they challenge the very practice of science. Discoveries once unimaginable except in science fiction are appearing at such a rapid rate that there is no time to evaluate their mora...

As the need for improved methods of assessing surgical competence grows, it is imperative to establish the basic infrastructure to ensure the ability to communicate among educators, education researchers, responsible training bodies, and credentialing boards. A workshop was conducted to provide a foundation for communication and a standardization o...

Numerous advanced technologies, both medical and nonmedical, are emerging faster than their social, behavioral, political, moral, and ethical implications can be understood. Some of these technologies will fundamentally challenge the practice of surgery: human cloning, genetic engineering, tissue engineering, intelligent robotics, nanotechnology, s...

The analogy between Minimally Invasive Surgery (MIS) and the human language inspires the decomposition of a surgical task into its primary elements. The frequency of different elements or words" and their sequential associations or "grammar" both hold critical information about the process and outcome of the procedure. Modeling these sequential ele...

A well-proven methodology (the modified Delphi method) was used to generate a first-order approximation of errors that should be measured in a virtual reality surgical simulator (the ES3). The methodology and the errors derived were crafted in such a way as to be generalizable. Although some of the error measures are specific for sinus surgery, the...

The history of surgery has many notable landmarks that have dramatically influenced the course of the practice of surgery, always in the direction of more scientific accomplishments. The Industrial Age produced the rise of the “Golden Age of Surgery” through the technologies of anesthesia, antisepsis, x-ray imaging, dedicated surgical operating roo...

The objective assessment of the psychomotor skills of surgeons is now a priority; however, this is a difficult task because of measurement difficulties associated with the assessment of surgery in vivo. In this study, virtual reality (VR) was used to overcome these problems. Twelve experienced (>50 minimal-access procedures), 12 inexperienced lapar...

To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assess...

The 2001 U.S. Army Medical Research and Materiel Command (USAMRMC) Biomedical Informatics Roadmap Meeting was devoted to developing a strategic plan in four focus areas: Hospital and Clinical Informatics, E-Health, Combat Health Informatics, and Bioinformatics and Biomedical Computation. The driving force of this Roadmap Meeting was the recent acce...