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Cognitive Training for Performance Enhancement in Robotic Surgery: A Systematic Review of RCTs.

Samy Castillo-Flores¹, Andres A Abreu¹, Patricia Viana²

¹Department of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.

Journal of Surgical Education

|February 11, 2026

Summary

This summary is machine-generated.

Cognitive training (CT) shows promise in enhancing robotic surgery skills for novice trainees, particularly through mental rehearsal techniques. However, more research is needed to confirm its effectiveness in advanced learners and real surgical settings.

Keywords:

cognitive training mental rehearsal robotic surgery simulation technical skills

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Area of Science:

Robotic Surgery
Surgical Education
Cognitive Training

Background:

Robotic surgery requires specialized technical skills.
Cognitive training (CT) may enhance surgical performance.
The efficacy of CT in robotic surgery training is under investigation.

Purpose of the Study:

To evaluate the impact of cognitive training (CT) versus standard non-cognitive training on surgical performance in robotic surgery simulations.

Main Methods:

A systematic review of randomized controlled trials (RCTs) was performed.
Studies were identified through searches of PubMed, Embase, ScienceDirect, and PsycINFO.
Risk of bias was assessed using the RoB 2 tool.

Main Results:

CT improved technical skills in 3 of 4 RCTs, showing reduced tissue piercing and superior knot-tying.
Augmented mental rehearsal improved visuospatial ability, while computer-based CT did not.
No improvement was observed in NOTSS scores.

Conclusions:

Cognitive training, especially mental rehearsal, may enhance robotic surgery simulation skills in novice trainees.
Evidence is limited by small, heterogeneous studies conducted solely in simulation settings.
The effectiveness of CT in advanced trainees and real-world surgical environments remains uncertain.