Early Learning Curve of a Novice Surgeon in Robot-Assisted Pulmonary Resection: Assessment Using the Robot-Assisted...

Objective The primary objective was to delineate the early learning trajectory of a junior thoracic surgeon with limited prior supervised exposure to video-assisted thoracoscopic surgery (VATS) lobectomy while performing robot-assisted pulmonary resection. The secondary objective was to evaluate technical proficiency, subjective performance, and cognitive workload across the first 15 consecutive supervised cases using validated assessment tools, including the Robot-Assisted Thoracic Surgery Assessment Tool (RATSAT), Surgery Task Load Index (SURG-TLX), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis. Methodology In this single-surgeon observational study conducted with retrospective IRB approval, a single junior thoracic surgeon with less than four years of post-residency experience and limited prior exposure to supervised VATS lobectomy cases performed 15 consecutive robot-assisted pulmonary resections under the supervision of an expert surgeon. We evaluated technical performance using the RATSAT, cognitive workload using the SURG-TLX, and operative time through RA-CUSUM analysis. Performance progression and interrater consistency were assessed. Results The trainees' and supervisors' RATSAT scores (31.0 ± 3.8 vs. 30.3 ± 3.9) showed positive correlations with case number (r = 0.72 and 0.55, respectively). Subjective performance ratings increased significantly between the early (cases 1-8) and late (cases 9-15) phases (50.0 ± 11.6 vs. 65.0 ± 12.6, P < 0.05), whereas differences in RATSAT scores were not significant (P = 0.14). Cognitive workload remained high with minimal decline (trainee's mean total SURG-TLX = 79.1 ± 4.8), and both RA-CUSUM models demonstrated an inflection point around case 8, indicating procedural stabilization. Conclusions This is one of the first longitudinal depictions of RATS from the perspective of a true novice surgeon. Subjective improvement preceded objective proficiency, suggesting early cognitive and procedural adaptations. These findings support the feasibility of structured robotic training at the novice level and highlight the value of workload-aware assessment in early surgical education.