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

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.