Residency robotic biotissue curriculum: the next frontier in robotic surgical training

Virtual reality has been shown to be a strong introduction to the robot. However, we hypothesized that a biotissue curriculum including common surgical anastomoses can further enhance robotic technical skills in surgical residents.

Post-graduate-year three (PGY-3) general surgery residents completed a two-week robotic simulation rotation. The inanimate exercises used biotissue to simulate common robotic anastomoses, including the running hepaticojejunostomy (RHJ), gastrojejunostomy (GJ), interrupted hepaticojejunostomy (IHJ), and pancreaticojejunostomy (PJ). Drills were timed and graded according to modified Objective Structured Assessment of Technical Skills (OSATS; range 6-30).

32 residents completed the curriculum. 81.3% of residents reported prior experience at the surgeon console (median=5 operations). Across all drills the average time to completion decreased from first to fourth attempt (RHJ: 33.7±8.9 vs. 26.3±8.1 min, p<0.001; GJ: 57.2±15.1 vs. 44.6±9.5 min, p<0.001; IHJ: 32.6±7.2 vs. 27.1±7.7 min, p<0.001; PJ: 44.2±9.3 vs. 35.6±10.5 min, p<0.001). Average OSATS score increased across all drills as well (RHJ: 16.0±3.8 vs. 23.3±3.4, p<0.001; GJ: 19.4±2.1 vs. 26.0±2.5, p<0.001; IHJ: 16.9±2.7 vs. 23.2±3.6, p<0.001, PJ: 17.9±2.6 vs. 23.6±3.6, p<0.001).

The robotic biotissue curriculum improves resident performance on robotic anastomoses. With the rise of the robotic platform, training in robotic procedures should be incorporated during surgical residency.