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Updated: Jun 1, 2025

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Utilizing objective performance indicators to assess resident autonomy during robotic cholecystectomy.

D Brock Hewitt1, Hardik Patel2, Shih-Hao Lee3

  • 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA. brock.hewitt@nyulangone.org.

Surgical Endoscopy
|January 17, 2025
PubMed
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Objective performance indicators (OPIs) from robotic surgery accurately assess surgical resident autonomy. Senior residents demonstrated greater autonomy during cholecystectomy compared to junior residents, highlighting OPIs

Area of Science:

  • Minimally Invasive Surgery
  • Surgical Education
  • Medical Technology

Background:

  • Traditional evaluation of surgical resident operative autonomy relies on subjective self-reports, which are susceptible to bias.
  • Objective Performance Indicators (OPIs) from robotic surgical systems offer a method for collecting unbiased intraoperative data.
  • This study explores the utility of OPIs in assessing resident autonomy during robotic cholecystectomy.

Purpose of the Study:

  • To investigate the capability of OPIs in characterizing surgical resident autonomy during robotic cholecystectomy.
  • To compare the operative autonomy between senior and junior surgical trainees.
  • To analyze the influence of case complexity on resident autonomy.

Main Methods:

  • Data from 82 robotic cholecystectomies were collected using the Intuitive Data Recorder between July 2020 and April 2023.
Keywords:
AutonomyObjective performance indicatorsRobotic cholecystectomySurgical education

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  • Surgeon-specific OPIs, including instrument active time (AT) and path length (PL), were analyzed for the overall procedure and specific dissection steps.
  • Analysis was stratified by trainee level (junior vs. senior) and case complexity (Parkland Grading Scale).

    • Main Results:

    • Senior trainees (PGY 4-7) performed significantly more of the cholecystectomy (median AT 0.6) than junior trainees (PGY 2-3) (median AT 0.4).
    • Junior residents exhibited less autonomy during the hepatocystic triangle dissection compared to senior residents.
    • Resident autonomy did not significantly vary with case complexity, but significant heterogeneity was observed within the senior trainee group.

    Conclusions:

    • OPIs effectively differentiate the intraoperative experience and autonomy levels of surgical trainees during robotic cholecystectomy.
    • Senior residents demonstrate greater procedural autonomy, but significant variability exists within this group.
    • OPIs represent a valuable tool for objective assessment of resident autonomy and for refining surgical training curricula.