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The Surgical Learning Curve: Does Robotic Technical Skill Explain Differences in Operative Performance?

Daniel P Bitner1, Saratu Kutana1, Katherine Carsky1

  • 1Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, New York, USA.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|January 20, 2023
PubMed
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This summary is machine-generated.

Technical skill variation did not explain differences among surgeons or novice learning curves. Global evaluative assessment of robotic skills (GEARS) scores showed limited change over time, suggesting other factors influence surgical performance.

Area of Science:

  • Surgical Education
  • Robotic Surgery
  • Medical Simulation

Background:

  • Prior technical skill assessments used small video datasets.
  • Surgeon performance likely varies and improves with training.
  • Technical skill is hypothesized to explain performance heterogeneity.

Purpose of the Study:

  • To investigate if technical skill, measured by Global Evaluative Assessment of Robotic Skills (GEARS), explains performance variations among surgeons.
  • To determine if technical skill improves over time for novice surgeons.
  • To identify potential surrogate metrics for surgical performance analysis.

Main Methods:

  • Analysis of 162 sleeve gastrectomy videos (July 2018-January 2021).
  • GEARS scores assigned by crowdsourced evaluators.
Keywords:
GEARS scoresrobotic surgical skillsurgical learning curve

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  • Statistical analysis included ANOVA, Tamhane's post hoc test, and linear regression.

    • Main Results:

    • Operative time varied significantly between surgeons, but overall GEARS scores did not.
    • Neither operative time nor total GEARS scores changed significantly over time.
    • Novice surgeons showed improvement in phase-adjusted operative time, but not overall GEARS scores, over time.
    • Force sensitivity, a subcomponent of GEARS, increased across all surgeons.

    Conclusions:

    • GEARS scores demonstrated less variability and did not improve with time for novice surgeons.
    • Improved technical skill, as measured by GEARS, does not fully explain the learning curve or inter-surgeon variability.
    • Further research is needed to define valid surrogate metrics for surgical performance.