Current training on the basics of robotic surgery in the Netherlands: Time for a multidisciplinary approach?

Introduction: The following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training? Methods: An online questionnaire was sent to 91 robot professionals in The Netherlands. The questionnaire contained 21 multiple-choice questions focusing on demographics, received robot training, and their opinion on basic skills training in robotic surgery. Results: The response rate was 62 % (n = 56): 13 general surgeons, 16 gynecologists, and 27 urologists. The urologists performed significantly more robotic procedures than surgeons and gynecologists. The kind of training of all professionals varied from a training program by Intuitive Surgical, master-apprenticeship with or without duo console, fellowship, and self-designed training programs. The training did neither differ significantly among the different specialties nor the year of starting robotic surgery. Majority of respondents favor an obliged training program including an examination for the basics of robot skills training. Conclusion: Training of the current robot professionals is mostly dependent on local circumstances and the manufacturer of the robot system. Training is independent of the year of start with robotic surgery and speciality. To guarantee the quality of future training of residents and fellows in robot-assisted surgery, clear training goals should be formulated and implemented. Since this study shows that current training of different specialities does not differ, training in robotic surgery could be started by a multidisciplinary basic skills training and assessment

The United States as Global Sheriff: Using Unilateral Sanctions to Combat Human Trafficking

In recent years, the issue of human trafficking - the recruitment or movement of persons by means of coercion or deception into exploitative labor or slavery-like practices - has moved from the margins to the mainstream political agenda. The rapid proliferation of international, regional and domestic anti-trafficking laws bespeaks universal condemnation of the practice, but belies deep divisions among States over how to define and approach the problem. It is thus significant that the international community was able to reach consensus and conclude a new international law on trafficking - the Palermo Protocol. But just weeks before the signing of the Protocol, the United States passed domestic anti-trafficking legislation with unsettling global reach. Authorizing unilateral sanctions against countries that fail to meet U.S. minimum standards for eliminating trafficking, the U.S. law provides a ready means for injecting U.S. domestic anti-trafficking norms into the international arena. This Article examines the significance of the U.S. sanctions regime for the fragile new international cooperation framework established under the Protocol. This Article begins by situating the U.S. rise to dominance in broader historical and political context, describing the controversies that plagued development of the Protocol and continue to influence U.S. trafficking policy. The Article then examines critiques of U.S. unilateralism through the lens of international law, and derives a critical framework for assessing the U.S. sanctions regime. Having established context and methodology, the Article assesses the sanctions regime\u27s capacity to promote progressive development of transnational anti-trafficking norms, and concludes with a modest proposal for improvement