Using virtual reality to maintain surgical skills during periods of robotic surgery inactivity

Is implementation of robotic-assisted procedures in acute care general surgery cost-effective?

Over the past 2 decades, the use and importance of robotic surgery in minimally invasive surgery has increased. Across various surgical specialties, robotic technology has gained popularity through its use of 3D visualization, optimal ergonomic positioning, and precise instrument manipulation. This growing interest has also been seen in acute care surgery, where laparoscopic procedures are used more frequently. Despite the growing popularity of robotic surgery in the acute care surgical realm, there is very little research on the utility of robotics regarding its effects on health outcomes and cost-effectiveness. The current literature indicates some value in utilizing robotic technology in specific urgent procedures, such as cholecystectomies and incarcerated hernia repairs; however, the high cost of robotic surgery was found to be a potential barrier to its widespread use in acute care surgery. This narrative literature review aims to determine the cost-effectiveness of robotic-assisted surgery (RAS) in surgical procedures that are often done in urgent settings: cholecystectomies, inguinal hernia repair, ventral hernia repair, and appendectomies.

A Standardized Robotic Training Curriculum in a General Surgery Program

Background and Objectives:

The general surgery residency at the University of Illinois College of Medicine at Peoria has a long tradition of integrating robotic surgery into training since 2002. The purpose of this paper is to investigate our curriculum and evaluation system, which was designed to achieve a standardized format for education in general robotic surgery.

Methods:

The curriculum consists of two phases: phase 1 (PGY 1–2): Complete 4 robotic surgery training modules; read two assigned robotic surgery articles; and practice simulation modules on the robot. phase 2 (PGY 3–5): Refresh training modules, score >90% on the simulator modules every 6 months; bedside assist minimum of 4 robotic procedures; and act as console surgeon for a minimum of 10 procedures with 2 separate attending surgeons. The required simulator modules were specially selected to incorporate all of the skills categories documented in the simulator. The faculty evaluate the resident's operative performance using the Global Evaluative Assessment of Robotic Skills validated rubric.

Results:

Since the curriculum was instituted in June 2017, 73 evaluations from 8 surgeons have been collected. We examined data from 6 residents who had at least 5 Global Evaluative Assessment of Robotic Skills assessments completed. Correlation coefficient scores showed a positive correlation ranging from 0.476 to 0.862 for average skills and 0.334 to 0.866 for overall performance scores.

Discussion:

The preliminary results suggest an improvement of resident robotic surgical skills through tailored education. This curriculum is designed to enhance robotic general surgery education that could potentially produce general surgeons able to operate robotically without needing a robotic/MIS (Minimally Invasive Surgery) fellowship.