Utilizing objective performance indicators to assess resident autonomy during robotic cholecystectomy

The current evaluation of surgical resident operative autonomy consists primarily of self-report and is prone to bias. Objective performance indicators (OPIs) generated from the da Vinci Surgical System capture objective intraoperative data providing an opportunity to evaluate the intraoperative resident experience more accurately. This study investigates the ability of OPIs to describe resident autonomy during robotic cholecystectomy.

The Intuitive Data Recorder captured OPI data during 82 robotic cholecystectomies performed at a single high-volume academic center between July 1st, 2020, and April 30th, 2023. Autonomy was characterized by evaluating surgeon-specific OPIs: instrument active time (AT) and path length (PL). OPIs were evaluated for the overall procedure, the hepatocystic triangle dissection, and the gallbladder fossa dissection. Analysis was stratified by trainee level and case complexity as defined by the Parkland Grading Scale.

Of the 82 cholecystectomies, surgical trainees participated in 77 cases, 59.7% (n = 46) involved senior trainees (PGY 4-7), and 40.3% (n = 31) involved junior trainees (PGY 2-3). By median AT, senior trainees performed 60% of the cholecystectomy (median AT 0.6 [IQR, 0.5 - 0.8]), significantly more compared to junior trainees at 40% (AT 0.4 [IQR 0.3 - 0.5]; P < 0.001). Junior residents had the least autonomy during the hepatocystic triangle dissection (P < 0.05) whereas no significant difference was present between annotated steps for senior trainees (P > 0.05). Resident autonomy did not vary significantly based on case complexity (P > 0.05). Overall, 76.1% of senior residents performed at least half of the cholecystectomy, significantly more compared to 32.3% of junior trainees (P < 0.001).

OPIs differentiated the surgical trainee experience during a robotic cholecystectomy. While senior trainees performed more of the procedure, there was significant within-group heterogeneity regarding the level of autonomy allotted. Moving forward, OPIs can be a valuable tool for characterizing resident autonomy and objectively informing surgical training curricula.