The value of simulation for training general surgery novices in robotic surgery: a systematic review

Simulation is the go-to option for robotic surgery education, though little is known about its impact on patient-related outcomes. The purpose of this review is to synthesize existing data on robotic simulations for training novice robotic general surgery residents and attendings associated with improved outcomes at Return on Investment (ROI) Levels 3-5 in comparison to no simulation training. The PRISMA-2020 Checklist was used to guide the reporting of the systematic review. A comprehensive search of 4 databases was performed using a combination of keywords and subject terms. Level 1 and 2 outcome papers, along with those not including general surgery residents or simulation as an intervention, were excluded. Data extraction and quality assessments were performed with findings synthesized in narrative themes. 1524 abstracts were imported into Covidence (a systematic review management software). Of those abstracts screened, 119 studies were selected for full-text screening, and a final set of nine studies met criteria for the review, including four studies with outcomes of ROI Level 3 and five studies with ROI Level 4. There were no Level 5 studies. Despite the increase in the use of simulation for robotic surgery training, there is limited evidence demonstrating the benefit of simulation on patient- and hospital-related outcomes. Synthesized data, although limited, points to a benefit in operating room time, cost, and blood loss. Future research should focus on conducting Level 5 studies to evaluate the cost-effectiveness of simulation in robotic surgery training.