The evolution of surgical skills simulation education: Robotic skills

Robotic surgery is now widely used after the introduction and increase in popularity of the da Vinci Xi Surgical System 25 years ago. Starting with urology, it has expanded into most major surgical specialties, with millions of robotic operations performed each year. With this growth comes the need to educate and train surgeons on its use. Robotic surgery introduces unique cognitive, psychomotor, and team-based skills not used in open and laparoscopic techniques. These demand creation of curricula on the basis of comprehensive and validated educational frameworks, similar to the Fundamentals of Endoscopic Surgery and Fundamentals of Laparoscopic Surgery programs, to train surgeons. Although programs like the Fundamentals of Robotic Surgery have been developed, they focus most on basic skills. Beyond curricula for these and more advanced skills, how performance is assessed is equally critical. Beginning to fill this gap are the Global Evaluative Assessment of Robotic Skills, Robotic Objective Structured Assessment of Technical Skills, and Robotic Ottawa Surgical Competency Operating Room Evaluation assessment tools. Continued development and improvement in curricula and assessment must persist, particularly as new technologies develop rapidly. Sophisticated features of newer robotic systems including objective performance indicators, augmented reality, virtual reality, artificial intelligence, and machine learning are gaining pace and are positioned to expand robotic surgery, and robotic surgical simulation education, even further over the next 25 years.