Consensus map for robotic right lower lobectomy-essential components for artificial intelligence and education...

The use of robotic-assisted thoracic surgery (RATS) is being increasingly adopted for many thoracic operations. Developing procedural maps based on expert consensus for RATS procedures can facilitate the learning and use of minimally invasive surgery by serving as the basis for training curricula or even more novel, artificial intelligence-based interventions. The purpose of this study was to use cognitive task analysis (CTA) to develop a consensus procedural map for robotic right lower lobectomy based on individual procedural maps from highly experienced robotic thoracic surgeons, identify operative phases and steps considered to be essential, and to identify patient and surgeon factors that influence operative decision making. Seven expert robotic thoracic surgeons were interviewed about operative decision-making in robotic right lower lobectomy using a CTA-based framework. Interviews were analyzed for operative phases/steps and patient/surgeon factors that influence operative decision-making. A follow-up survey was then performed to assess whether consensus existed regarding the importance of each identified aspect. Interviewing 7 surgeons led to the identification of 32 unique operative steps, of which 28 (87.5%) were regarded as important by at least 5 of 7 surgeons. Of the 14 patient and 13 surgeon aspects, only 7 (50%) and 11 (84.6%) met consensus criteria. Using CTA, we developed a consensus procedural map of robotic right lobectomy in which the majority of identified operative steps reached consensus threshold for importance. These findings can form the basis for future work in artificial intelligence and curricula development to facilitate the adoption of RATS techniques.