Purpose

This $25,000 advanced fellowship opportunity will be awarded to a surgeon and their institution to support and facilitate the initiation of a high quality robotic cardiac surgery program at their home institution. Applicants must attend the STS Workshop on Robotic Cardiac Surgery, meet specific requirements confirming institutional support and resources, and have experience performing mitral valve repair and replacement. The fellow will be assigned to an STS proctor, who will then serve as the primary mentor/sponsor and assist the fellow with five robotic cases at the fellow’s institution. This fellowship is supported by the generosity of Intuitive.

This advanced Fellowship has two pathways: CABG or Mitral. It is expected that applicants should have significant experience performing CABG or mitral valve repair and replacement depending on the desired pathway.

Requirements

1. Letter of support from the chief of cardiothoracic surgery at the institution of the surgeon applicant.
2. Letter of support from an appropriate hospital administrator (such as service line director, COO, or CEO) confirming the necessary resources and program support commitment, as outlined below:
   • Minimum Operating room block time of 2 full days per week of robotic surgery OR systems (with availability for the first case in the morning);
   • Confirmation that surgeon applicant’s institution has invested in the necessary ancillary equipment and supplies (which may amount to an investment of several hundred thousand dollars);
   • Confirmation of support for surgeon applicant and team robotic surgery training time and expenses;
   • Confirmation of support for a dedicated initial operating room team;
   • Assurance of confirmed support by anesthesia, nursing, and perfusion leaders;
   • Confirmation of the clinical volumes reported by the surgeon applicant (see further below);
   • Confirmation that surgeon applicant’s institution will cover the remainder of training and other associated costs, including the proctoring costs set forth in the “Expenses” section below.
   • Submit an initial Cardiovascular Robotic Team Development Plan. This Development Plan can be assembled and administrated by a local institutional administrator or an industry consultant. The institution must be aware that Intuitive Surgical representatives are not trained to cover cardiac cases, and that a detailed training plan is necessary. This plan should include various milestones such as Onsite Training, daVinci TR100 & TR200 Training Labs, instrumentation acquisition, cadaver lab, simulated cases, and proctor engagement.

3. Surgeon applicant and first assist (other team members optional) must have attended the STS Workshop on Robotic Cardiac Surgery (2-day course) on May 9-10, 2024.
4. Surgeon applicant must meet the minimum requirements with respect to Training & Practice and Clinical Experience, as per “Contemporary Robotic Cardiac Surgical Training, Badhwar et al, prepress online: 11/10/2021, JTCVS,” appropriate for the fellowship track:

Robotic Revascularization Program:

• American Board of Thoracic Surgery accreditation or equivalent
• 3 years of independent attending-level clinical practice, and/or a minimum 1-yearpost-graduate robotic cardiac fellowship with robotic revascularization concentration
• 250 career cases of coronary revascularization as primary operator (on or off pump) withan O/E of ≤ 1, of which 50 should be off pump

Robotic Valve/Intercardiac Program:

• American Board of Thoracic Surgery accreditation or equivalent
• 3 years of independent attending level clinical practice, and/or a minimum 1-yearpost-graduate robotic cardiac fellowship with robotic valve concentration
• 75 career cases of mitral valve repair or replacement, with or without concomitant procedures that may include surgical ablation, with an O/E of ≤ 1, of which 50should be within the prior two years
• 15 cases of valve/intracardiac operations performed via minimally invasive thoracotomy involving peripheral cardiopulmonary bypass performed within the prior two year with O/E of ≤ 1

5. Institutional Resources Including:

• 250 adult cardiac surgical cases per year for a minimum of 3 years
• A dedicated team of institutionally based cardiac anesthesiologists practicing routine use of transesophageal echocardiography
• A dedicated team of institutionally based perfusionists
• Immediate institutional access to advanced mechanical circulatory

Application Process

1. Any surgeon applicant and their first assist must have first attended the STS Robotic Cardiac Surgery Workshop.
2. Application must address all requirements noted in the “Requirements” section above.
3. Surgeon applicant must designate one desired training pathway, robotic mitral valve or coronary, and indicate any desired technique preferences, which will guide the mentor-sponsor selection.
4. Applications will be accepted through June 10, 2024, and will be reviewed by the TSF Robotic Surgery Fellowship Award Committee.
5. The TSF Robotic Surgery Fellowship Award Committee will make selections based on the quality of applications and fellowship funds available.
6. The STS Robotic Cardiac Surgery Task Force will designate one experienced surgeon task force member to serve as the primary mentor-sponsor of each successful surgeon applicant for the duration of the fellowship program.
7. Surgeon applicant and their institution will be notified of acceptance or rejection.

The fellowship winner will be notified within six weeks following the application deadline.

Training Timeline

The fellowship will begin on September 1, 2024.

1. The surgeon fellow and first assistant complete the robotic equipment device manufacturer-required 1-day device training (T-100 training).
2. The surgeon fellow and first assistant complete an STS 1-day procedural-specialty specific training course with their designated STS mentor-sponsor at a training facility deemed appropriate by the STS Robotic Cardiac Surgery Task Force (T-200 training).
3. The surgeon fellow and team (first assistant, anesthesiologist, perfusionist, circulating nurse, scrub nurse or tech – 5 member team) travels to the mentor-sponsor’s program (high-volume training institution & surgeon), observes 2 cases, and performs 1 simulated robotic procedure.
4. Surgeon fellow and team perform 10 simulated procedures at their home institution (2/week).
5. The surgeon fellow selects 5 appropriate clinical cases to be approved and proctored by an STS proctor (ideally the mentor-sponsor but can be another surgeon, with the approval of the STS Robotic Cardiac Surgery Task Force).
6. The proctor fills out an evaluation sheet for each case and sends them to the mentor-sponsor (if the mentor-sponsor is also the proctor, s/he fills out an evaluation sheet for each case).
7. The mentor-sponsor reviews the evaluations of the first 5 cases with the surgeon fellow.
8. The surgeon fellow & team then completes another 10 cases without a proctor for a total of 15 cases (to be completed within 6 months).
9. The mentor-sponsor is available throughout the fellowship period to advise the surgeon fellow.
10. Details and results of the proctor’s evaluation sheet and the surgeon fellow’s results of first 15 cases are reviewed confidentially by the mentor-sponsor (if the mentor-sponsor is also the proctor, s/he is already in a position to conduct the necessary confidential review) and then the STS Robotic Cardiac Surgery Task Force.
11. The STS Robotic Cardiac Surgery Task Force decides whether to award a certificate of completion.
12. The STS Robotic Cardiac Surgery Task Force does not certify clinical competency, but simply indicates that the program was completed.
13. No decision to withhold a certificate of completion is final unless and until confirmed for procedural fairness by the STS Board of Directors or the STS Executive Committee.

Award Completion Process

1. TSF notifies the surgeon fellow and institution of completion.
2. Certificate of program completion is presented to the surgeon fellow at TSF Reception during the STS Annual Meeting.

Expenses

TSF will fund a training grant to the awardee and institution of $25,000. This funding is intended to offset costs for the team training and travel and lodging, proctor honorarium and expenses, and course registration fees for:

1. Surgeon fellow & team case observation program (2 cases, 1 simulation exercise or “mock case” over 2 days for surgeon fellow, first assistant, anesthesiologist, perfusionist, circulating nurse, scrub nurse or technician – 5 person team);
2. One 2-day procedural-specialty specific training course (TR-200) at Intuitive facility; travel and lodging for surgeon fellow & first assistant and STS mentor-sponsor surgeon; and
3. Proctoring per case honorarium and reasonable travel expenses (for 5 cases). In this regard, institution of surgeon fellow will pay an honorarium of $1,000 for each of the 5 proctored cases, and will reimburse proctor’s reasonable related travel expenses for each case in accordance with its own established policies and procedures.

Timeline

Application Closes: June 10, 2024