Novel Robotic Esophagogastric Anastomosis Simulation Model for Skill Development and Training

Esophagogastric anastomosis is a critical step of esophagectomy. We aimed to develop a novel robotic esophagectomy simulator with high rates of fidelity and educational value for trainee surgeons to advance these skills in a low-risk setting.

A porcine esophagus-stomach block was secured on a platform resembling the anatomy during an esophagectomy, and a da Vinci Xi (Intuitive Surgical) robotic system was docked above it. Participants completed 5 key steps (creating the gastric conduit, transecting the esophagus, making the gastrotomy and esophagotomy, creating the anastomosis, and sewing the common enterotomy). The model was assessed through surveys under domains of fidelity (surgical field, reality of materials, anatomy, and experience) and value as a training tool on a scale of 1 to 5 (strongly disagree to strongly agree).

Of 14 participants, 8 (57.1%) were women, 9 (64.3%) were integrated cardiothoracic surgery residents, 1 (7.1%) was a thoracic-track resident, and 10 (71.4%) were in postgraduate year 4 or higher. Participants thought most aspects of the model had high fidelity, including the anatomy of conduit (4.8 ± 0.4) and proximal esophagus (4.9 ± 0.4), realism of the stomach (4.9 ± 0.4) and esophagus (4.9 ± 0.4), stapling (4.7 ± 0.6), suturing (4.8 ± 0.4), and tissue handling (4.4 ± 0.6). Participants rated the model highly overall (4.7 ± 0.5) and as a training tool (4.9 ± 0.4), with strong interrater reliability (0.69).

The robotic esophagogastric simulation model demonstrated high fidelity and value as a training tool, suggesting its potential effectiveness for surgeons with limited experience. However, it warrants further refinement to address limitations and to optimize its value as a training tool.