Intraoperative Teaching in Robotic-Assisted Surgery-A Systematic Review

Background/Objectives: Robotic-assisted surgery (RAS) teaching, using simulation, has been examined widely. Less is known about teaching in the intraoperative environment. We conducted a systematic review of skills, strategies and facilities necessary for intraoperative RAS teaching. Methods: A systematic review of evidence on RAS curricula and teaching was conducted using MEDLINE, PubMed, Embase, CINAHL and PsycINFO in February 2024, updated in June 2025. A total of 10,000 references were screened for eligibility using the PICO (population, intervention, comparator, outcomes) framework, with a focus on surgeons and intraoperative RAS teaching. Data were extracted and analysed thematically using NVivo 14. Methodological quality was assessed using the MMERSQI (Modified Medical Education Research Study Quality Instrument) criteria and the Joanna Briggs (JBI) critical appraisal tool. The review was registered with PROSPERO under CRD42024566778. Results: A total of 16 publications met the inclusion criteria. Most studies were small, used qualitative methodologies and were conducted in general or colorectal surgery. Verbal instruction was the most common teaching method. Force sensitivity, robotic control, including retraction, perception of the field and team management were skills taught intraoperatively. RAS training-the-trainer publications focused on enhancing autonomy. Conclusions: The volume of available evidence is low. Trainee autonomy is the main challenge in intraoperative RAS training and may be enhanced by training-the-trainer skills training. Verbal teaching accompanied by a demonstrative gesture appears to be useful. Intraoperative RAS skills taught include third arm retraction, awareness of the field and management of the bedside team. The use of a dual console to facilitate teaching is endorsed by most RAS trainers but is not an absolute requirement for training.