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Robotic Hands-on course co-organised by EHS and Intuitive
First name
Last name
Email
Current position/title
Institution/hospital affiliation
Resident?
Yes
No
Year of residency
Choose year of residency
1st year
2nd year
3rd year
4th year
5th year
Senior resident
Years of experience in General Surgery
Years of experience in Hernia Surgery
Is there a daVinci system at your hospital?
Yes, Xi system
Yes, Si system
Yes X system
No
Do you have the 'Certificate of daVinci Online Training' as console surgeon? (TR100)
Yes, I will upload the certificate below
No, but I will get it before joining the course.
Do you have a simulator training on the daVinci system?
Yes
No, but the hospital has a simulator and I will train.
No, but I wil try to get some training before the course.
If Yes, how many hours of simulator training you had?
Experience robotic surgery
None
>10 cases
<10 cases
Level of training
Surgeon (Fellow)
Surgeon (Staff member)
Surgeon (in training)
Please write below the position since...(year)
Experience robotic hernia surgery
None
>10 cases
<10 cases
Why do you wish to attend this course?
Attachment - please upload your 'Certificate of daVinci Online Training' if any
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