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Early Learning Curve of a Novice Surgeon in Robot-Assisted Pulmonary Resection: Assessment Using the Robot-Assisted
Keita Ishido1,2, Akira Fukunaga3, Saseem Poudel4
1Surgery, Asahikawa City Hospital, Asahikawa, JPN.
Cureus
|July 23, 2026
Summary
This study tracks a junior surgeon
Area of Science:
- Thoracic Surgery
- Surgical Education
- Robotic Surgery
Background:
- Limited data exists on the early learning curve for novice surgeons in robot-assisted thoracic surgery (RATS).
- Assessing technical skills, subjective performance, and cognitive workload is crucial for effective surgical training.
Purpose of the Study:
- To delineate the learning trajectory of a junior thoracic surgeon in robot-assisted pulmonary resection.
- To evaluate technical proficiency, subjective performance, and cognitive workload during the initial 15 supervised RATS cases.
Main Methods:
- A single-surgeon observational study of 15 consecutive robot-assisted pulmonary resections.
- Utilized Robot-Assisted Thoracic Surgery Assessment Tool (RATSAT), Surgery Task Load Index (SURG-TLX), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis.
- Assessed performance progression and interrater consistency.
Main Results:
- Trainee and supervisor RATSAT scores correlated positively with case number.
- Subjective performance ratings significantly increased from early to late phases (cases 1-8 vs. 9-15).
- Cognitive workload remained high, and RA-CUSUM indicated procedural stabilization around case 8.
Conclusions:
- Subjective improvement in robot-assisted thoracic surgery skills preceded objective proficiency in novice surgeons.
- Structured robotic training is feasible for novice surgeons.
- Workload-aware assessment is valuable in early surgical education.
