Behind the pattern: General surgery residsent autonomy in robotic surgery.

Area of Science:

• Surgical Education
• Robotic Surgery Training
• Medical Simulation

Background:

• Robotic surgery is integral to general surgery training.
• Understanding factors influencing resident operative autonomy is crucial for effective training.

Purpose of the Study:

• To investigate factors affecting general surgery residents' operative autonomy in robotic-assisted surgery (RAS).
• To analyze the influence of resident seniority, surgeon experience, RAS case volume, and procedure type on resident individual console time (ICT).

Main Methods:

• Retrospective analysis of resident ICT data for robotic cholecystectomy, inguinal hernia, and ventral hernia repairs.
• Sequential explanatory mixed-methods approach with qualitative interviews with surgeons.
• Inclusion of postgraduate year (PGY) 2-5 residents as console surgeons.

Main Results:

• Senior residents (PGY4-5) had higher ICT (42.4%) than junior residents (PGY2-3) (26.8%).
• Experienced surgeons (over 10 years) granted less ICT to both junior and senior residents compared to early-career surgeons.
• Robotic cholecystectomy offered the most ICT (45.8%), followed by inguinal hernia (36.7%) and ventral hernia (28.6%).
• Surgeon case volume did not correlate with resident ICT.

Conclusions:

• Resident autonomy in RAS is influenced by resident seniority, surgeon experience, and procedure type.
• Surgeon assessment of resident experience and perceived time pressure inversely affect resident ICT.
• Robotic surgery training programs must address external pressures to enhance resident operative autonomy.