Do Surgical Trainees Impact Surgeon Robotic Learning Curves?

Area of Science:

• Minimally Invasive Surgery
• Surgical Education
• Medical Technology Assessment

Background:

• Inter-surgeon variability in robotic surgery learning curves is poorly understood.
• The impact of trainee involvement and formal training curricula on these curves is unclear.
• Cumulative sum (CUSUM) analysis is a validated tool for assessing surgical learning curves.

Purpose of the Study:

• To utilize CUSUM analysis to evaluate learning curves in robotic-assisted cholecystectomies.
• To investigate the influence of surgical trainees on operative times and learning phases.
• To assess the effect of a formal robotic surgery training curriculum on learning curve trajectories.

Main Methods:

• Retrospective analysis of 707 robotic-assisted cholecystectomies performed by 7 surgeons (2012-2022).
• CUSUM analysis applied to operative time to generate learning curves for each surgeon.
• Trainee involvement analyzed by postgraduate year; curriculum implementation in 2016.

Main Results:

• Five of seven surgeons showed a distinct learning phase (20-59 cases); two had baseline proficiency.
• High trainee participation (94.5%) and consistent seniority distribution did not reduce learning curve variability.
• Implementation of a robotic surgery curriculum did not significantly alter individual surgeon learning curve trajectories.

Conclusions:

• Robotic-assisted cholecystectomy learning curves are highly surgeon-specific.
• Trainee involvement and formal training curricula did not demonstrably impact the identified learning curve variability or trajectories.
• Further research is needed to understand and mitigate inter-surgeon variability in robotic surgery proficiency.