Teaching landscape of robotic anatomic lung resection: an analysis of the da Vinci system dual console use in the US

We sought to characterize the utilization of the dual console (DC) teaching setup for daVinci robotic-assisted anatomic lung resections on a US national level. Intuitive da Vinci robotic system data for thoracic lobectomy and segmentectomy procedures between 2021 and 2022 were included. DC utilization was categorized as never, low, medium or high for surgeons performing 0, < 50%, 50-90% or > 90% of resections with DC activation, respectively. Surgeons and procedure factors associated with DC use was analyzed using binary logistic regression. During the study period, 38,552 lobectomy and 4,955 segmentectomy procedures were performed by 868 unique surgeons. A total of 555 surgeons (63.9%) performed anatomic lung resections using the DC, whereas 313 surgeons (36.1%) never used the DC. Amongst DC users, 176 (31.7%) surgeons were classified as low, 216 (38.9%) as medium and 163 (29.3%) as high utilizers. DC use varied significantly between surgeons based on experience (p = 0.018), with the greatest proportion of high utilizers being surgeons with less than 5 years of experience on the robot. Overall, the DC was used for 42.9% of anatomic lung resection. DC use was higher for segmentectomy than for lobectomy procedures (54.9% vs. 41.4%; p < 0.001). The median console time was 18 min longer with the DC setup (123.9 vs. 105.1 min, p < 0.001). On multivariable analysis, stapler use and Academic or VA/DOD hospital setting were associated with the highest rates of dual console activation. The dual console teaching setup is being used by almost two thirds of surgeons in the US. However, the significant variation of dual console activation indicates a wavering level of participation in teaching amongst surgeons. Further research is needed on robotic trainee involvement and pathways to autonomy for the next generation of thoracic surgeons.