Cory Richardson, MD, Mariangela Rivera, MD, Heidi Ryan, MD, Shawn Tsuda, MD. University of Nevada School of Medicine.
Background: As robotic surgical systems become more commonly used for general surgery procedures, growing numbers of residents will desire exposure to these systems during their residency training. Currently, residents finish their training with various levels of knowledge and ability in regard to robotic-assisted surgery. Currently there is no Resident Review Committee requirement for robotic-assisted surgery, however as robotic surgery becomes more common, appropriate training may be necessary during residency. The aim of this study was to assess the baseline skill sets of da Vinci naïve surgical residents and to identify initial resident impressions and knowledge regarding robotic surgical systems. Our study also examines the effectiveness of a brief training session and orientation to these systems.
Methods and Procedures: General surgical residents (n=8) in an academic program (that does not currently perform robotic surgery at its main teaching hospital) were offered an online orientation to the Da Vinci Surgical System (DVSS), followed by a three hour hands-on orientation by an Intuitive representative and a DVSS-certified general surgeon. A pre- and post- orientation survey was administered to each participant to evaluate impressions and knowledge of the DVSS. During the hands-on orientation, the participants were asked to perform a session of the Camera Targeting 1 and Peg Board 1 simulation. Scores were recorded and expressed as mean with standard deviation.
Results: Eight participants ranged in PGY level from 1-4. The percent of subjects who participated in da Vinci cases prior to orientation was 37.5%. No participants were FLS certified. The mean score for the Camera Targeting 1 simulation was 61.7 +/- 17.4, while the mean score for the Peg Board 1 simulation was 69.7 +/- 10.2. The current suggested general surgery resident da Vinci clinical pathway scores are 75% or greater. Sixty-two percent of participants were able to name five procedures performed by the DVSS prior to orientation, while 87.5% were able to after orientation. No participants were able to name five advantages of the DVSS described by Intuitive prior to or after orientation. The most common cited disadvantage prior to orientation was cost, the most common after was additional training or learning curve. Sixty-six percent of participants had interest in learning the DVSS during residency.
Conclusion: Residents have varied exposure to the DaVinci surgical system during their training. First-time simulation scores in robot naïve residents are only slightly below the pathway scores recommended by Intuitive, inferring that novice robot surgeons would likely achieve these recommended scores by completion of the pathway. In addition, a simple introductory training course effectively orients residents to the limitations and qualities of this operating system with improvement in basic knowledge of the DVSS.
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