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

To evaluate the effect of cognitive training (CT) compared to standard non-cognitive training on surgical performance in robotic surgery.

A systematic search of PubMed, Embase, ScienceDirect, and PsycINFO was conducted in accordance with PRISMA and Cochrane Handbook guidelines. Only randomized controlled trials (RCTs) were included. Risk of bias was assessed using the RoB 2 tool.

All studies took place in institutional training environments using simulation platforms.

One hundred fifty four surgical trainees (medical students, residents, and fellows) were included. Of these, 78 participants (50.6%) received CT through mental rehearsal or computer-based training.

Four randomized controlled trials (RCTs) were included. CT improved technical skills in 3 out of 4 studies. Reported benefits included a 52% reduction in tissue piercing (p < 0.001), superior knot-tying task performance (p = 0.01), and higher GEARS scores (CT group: mean of 13.1, SD 3.25; control group: mean of 11.4, SD 2.97; p = 0.03). NOTSS score showed no improvement (CT group: mean of 25.8, SD 7.34; control group: mean of 26.4, SD 9.13; p = 0.77). In contrast, an augmented mental rehearsal approach improved imagery and visuospatial ability (augmented CT group: mean of 20.1, SD 4.0; control group: mean of 14.6, SD 3.9; p = 0.02), whereas computer-based CT produced no improvement.

CT, particularly mental rehearsal, may improve technical skills in robotic simulation among novice trainees. However, the certainty of this evidence is limited by small, heterogeneous studies, and all findings come from simulation settings. Finally, the impact of CT in more advanced learners and in real operating rooms remains uncertain.