Structured Resident Training in Robotic Surgery: Recommendations of the Robotic Surgery Education Working Group

Prediction of Basic Robotic Competence for Robotic Visceral Operations Using the O-Score within the "Robotic Curriculum for Young Surgeons" (RoCS)

INTRODUCTION

Surgical residency programs lack structured assessments of robotic surgery. The validated O-Score is an assessment tool for tracking robotic operative proficiency consisting of 9 items on a 5 point Likert scale. Surgical autonomy is one comprehensive binary item. This study aimed to establish a benchmark for the number of procedures and the O-Score sum score to achieve surgical autonomy in robotic visceral procedures.

MATERIAL AND METHODS

This single-center prospective pilot cohort study assessed robotic procedures between 2020 and 2023. Bedside and console assistance performances were analyzed separately based on the O-Score and the calculated total numerical sum of the individual item values of the O-Score. Bedside assistance was conducted for upper gastrointestinal, hepatopancreatobiliary, and colorectal procedures, whereas console assistance referred to either one of the three areas. The study participants included inexperienced robotic surgeons who were evaluated by 2 robotic experts.

RESULTS

In total, 273 procedures were included in this study. For 13 bedside assistants, 273 O-Score assessments were identified, and 62 O-Score assessments for six console assistants. Surgical autonomy was achieved in 50.9% for bedside assistance and in 11.3 % for assistance at the robotic console. Surgical autonomy was positively correlated with the O-Score sum for bedside (p = < 0.001) and console assistance (p = 0.004). The positive prediction of surgical autonomy for bedside (console) assistance ranged from 74% (60%) to 93% (100%), correlated with a range of the O-Score sum between 37 (37) and 40 (40) and a robotic caseload between 19 (17) and 33 (24) procedures.

CONCLUSIONS

A significant improvement in the basic robotic performance was observed. Benchmarks regarding number of cases and O-Score sum were established for bedside assistance regardless of the type of visceral robotic operation. Currently, data on console assistance are limited. Monitoring robotic operative skills and skill progression is feasible in daily routine using the O-Score and O-Score sum.

The Society of Thoracic Surgeons Expert Consensus Statements on a Framework for a Standardized National Robotic Curriculum for Thoracic Surgery Trainees

OBJECTIVE

With robotic technology's rapid growth and integration, an urgent need to bridge the educational gap in thoracic surgical training has emerged. This document, a result of consensus among a group of experts in the practice and training of robotic surgery from The Society of Thoracic Surgeons, aims to provide a framework for a standardized national robotic curriculum for thoracic surgery trainees.

METHODS

The Society of Thoracic Surgeons Task Force on Robotic Thoracic Surgery and Workforce on E-learning and Educational Innovation assembled an expert group with the input of the Thoracic Surgery Director's Association. A focused literature review was performed, and expert consensus statements were developed using a modified Delphi process to address 3 major themes: (1) program expectations, (2) components of training, and (3) assessment and feedback.

RESULTS

A consensus was reached on 12 recommendations. These consensus statements reflect updated insights on developing a standardized robotics curriculum based on the latest literature and current educational experience, focusing on program expectations and educational guidelines to develop an optimal training curriculum.

CONCLUSIONS

The expert panel provides several key recommendations to provide a framework for developing a standardized national robotic thoracic curriculum, which would improve resident education and abridge any educational disparity that may exist among programs.

National survey on data governance and digital surgery: Challenges and opportunities for surgeons in the era of artificial intelligence

INTRODUCTION

This study evaluates the knowledge of Spanish surgeons regarding data governance and Digital Surgery, their usage, errors, and training deficiencies, as well as differences in knowledge between those who perform robotic surgery and those who do not.

METHODS

A descriptive study was conducted using a closed survey promoted by the Minimally Invasive Surgery and Technological Innovation Section of the Spanish Association of Surgeons, directed at its members between February and March 2024.

RESULTS

Out of 1086 surgeons contacted, 396 responded (36.46%). While 98.3% use electronic medical records, 45.4% lack organized data recording systems. Although 55.9% have access to robotic technology, 70.6% do not use it directly. Surgeons who perform robotic surgery show a higher general knowledge of Digital Surgery terms (7.2 vs 6.619; P = .215) and specifically of "Artificial Intelligence" (57.14% compared to less than 25% for other terms), although these differences are not significant. However, there are significant differences in interest in digital technology between those who perform robotic surgery and those who do not (P = .023). Additionally, surgeons who support training in digital technology during residency are nearly twice as likely to research Digital Surgery.

CONCLUSION

Surgeons are crucial for the digital transformation in surgery, but many are poorly prepared and insufficiently involved. Those who practice robotic surgery have more knowledge and interest in digital technology, highlighting the need for improved training and governance frameworks to better integrate surgeons into the digital era.

Navigating the Intersection of Technology and Surgical Education: Advancements, Challenges, and Ethical Considerations in Orthopedic Training

The emergence of technological advancements such as artificial intelligence, virtual reality, and robotics may offer new solutions to address crucial deficiencies in surgical residency training. However, these technologies also introduce ethical dilemmas and practical complexities. Achieving a balance between embracing innovation and refining traditional surgical techniques is essential in molding well-rounded, proficient surgeons. Addressing concerns such as disparities in access to technology and the risk of excessive automated system dependence demands thorough deliberation and the establishment of universal guidelines. By approaching these challenges with care and insight, surgeons can utilize new technology to elevate both surgical training and outcomes.

Surgical Outcomes and Utilization of Laparoscopic Versus Robotic Techniques for Elective Colectomy in Asian American and Native Hawaiian-Pacific Islanders (AAPI) Diagnosed With Colon Cancer

INTRODUCTION

Asian American and Native Hawaiian-Pacific Islanders (AAPI) are the fastest growing racial-ethnic group, with 18.9 million people in 2019, and is predicted to rise to 46 million by 2060. Colorectal cancer (CRC) is the most common cancer in AAPI men and the third most common in women. Treatment techniques like laparoscopic colectomy (LC) emerged as the standard of care for CRC resections; however, new robotic technologies can be advantageous. Few studies have compared clinical outcomes across minimally invasive approaches for AAPI patients with CRC. This study compares utilization and clinical outcomes of LC versus robotic colectomies (RCs) in AAPI patients.

METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program database for elective RC and LC in AAPI patients from 2012 to 2020. Outcomes included unplanned conversion to open, operative time, complications, 30-d mortality, and length of stay. Multivariable logistic regression analyses assessed the association between outcomes and the operative approach.

RESULTS

Between 2012 and 2020, 83,841 patients underwent elective LC or RC. Four thousand six hundred fifty-eight AAPI patients underwent 3817 (82%) LCs and 841 (18%) RCs. In 2012, all procedures were performed laparoscopically; by 2020, 27% were robotic. Mean operative time was shorter in LC (192 versus 249 min, P < 0.001). On multivariable logistic regression, there was no difference in infection (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.59-1.12), anastomotic leak (OR 0.97, 95% CI 0.59-1.61), or death (OR 0.9, 95% CI 0.31-2.61). Length of stay was shorter for RC (-0.44 d, 95% CI -0.71 to -0.18 d).

CONCLUSIONS

Overall, AAPI postoperative outcomes are similar between LC and RC. Future studies that evaluate costs and resource utilization can assist hospitals in determining whether implementing robotic-assisted technologies in their hospitals and communities will be appropriate.

Is the robotic revolution stunting surgical skills?

This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow.

Key message

The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.

How to integrate robotic training in surgical residency? An example of a 2-week robotic rotation

General surgery residents should be proficiently trained in robotic surgery. However, there is currently no standardized robotic training curriculum. We aimed to evaluate two approaches to a robotic curriculum and how implementing a virtual reality (VR) simulation curriculum improves trainee robotic performance. From 2019 to 2022, two models of a robotic training curriculum were examined: an in-unit rotation (IUR) and a 2-week curriculum (2WR). The VR curriculum was completed using the da Vinci® Skill Simulator. The curriculum used a pre/post-test design. Residents completed a pre-test that consisted of 4 VR exercises (graded 0-100%) and 3 inanimate box trainer exercises (graded using modified Objective Structured Assessment of Technical Skills). Then, residents completed a VR curriculum of 23 modules. Following the curriculum, residents were given a post-test with the same pre-test exercises. Time necessary to complete the curriculum and compliance were recorded. Of the 11 residents who participated in the IUR, 4 completed the VR curriculum. Comparatively, 100% (n = 23) of residents in the 2WR completed the curriculum. Average time to complete the VR curriculum was 3.8 h. After completion of the 2WR curriculum, resident performance improved from pre-test to post-test: VR test scores increased (160% vs 223%, p < 0.001), OSATS scores increased (15.0 vs 21.0, p < 0.001), and time to complete inanimate exercises decreased (1083 vs 756 s, p = 0.001). Residents who mastered all modules had higher post-test VR scores (241% vs 214%, p = 0.024). General surgery residents demonstrated improved compliance with the 2WR. The VR curriculum improved resident robotic performance in both virtual and inanimate domains.

Early introduction of simulation in the medical curriculum: the MedInTo perspective

Despite the increasing body of evidence supporting the use of simulation in medicine, a question remains: when should we introduce it into the medical school's curriculum? We present the experience and future perspectives of the MD program in Medicine and Surgery of University of Turin-MedInTo. Since its launch, MedInTo has been dedicated to integrating innovative teaching approaches at the early stages into the medical curriculum. Herewith, we describe a case-based approach for our activities, which includes the utilization of simulation for emergency medical care training for students and the integration of virtual and augmented reality technology. Dedicated surgical training activities using virtual-augmented reality and life-like simulator for students are also described.