Ruling the robot: a phase-based analysis of resident autonomy across core robotic general surgery procedures

Robotic surgery has become foundational in general surgery training, yet limited data exist on resident participation in core robotic procedures. This study assessed resident involvement in robotic cholecystectomies and inguinal hernia repairs (IHR) across operative phases and postgraduate year to characterize how participation evolves throughout training.

A retrospective review of robotic cholecystectomies and unilateral IHR performed over a single academic year at one tertiary academic institution was conducted using My Intuitive App case logs. Cholecystectomies were divided into three phases (dissection, clipping, removal) and IHR into two phases (dissection, reconstruction). Resident participation was quantified for each phase and the overall case. Differences by postgraduate year were assessed using one-way ANOVA, junior (PGY2/3) versus senior (PGY4/5) comparisons using two-sample t-tests, and inter-phase participation using repeated measures ANOVA.

151 robotic cholecystectomies and 101 robotic unilateral IHR performed by seven surgeons met inclusion criteria. Resident participation in cholecystectomy measured 50.7% (dissection), 90.5% (clipping), 89.4% (removal), and 72.1% (overall) compared to attending surgeons. For IHR, participation measured 44.8% (dissection), 72.5% (reconstruction), and 57.4% (overall). Across postgraduate years, significant differences in participation were identified in the cholecystectomy dissection (p < 0.001), clipping (p = 0.001), and overall case (p < 0.001), but not the removal phase (p = 0.077). For IHR, significant differences were identified across all phases (p < 0.001). Senior residents participated significantly more than junior residents across all phases for both procedures. In both case types, resident participation in the dissection phase significantly lagged behind all other phases regardless of postgraduate year.

Resident participation in robotic cholecystectomy and IHR varies significantly by operative phase and training level. Dissection consistently represents the phase of lowest resident involvement, while senior residents demonstrate greater autonomy across all phases. These findings underscore the importance of phase-level operative data in understanding resident progression and informing competency-based surgical training.