General Surgery Trainees Seek Robotic Exposure, but Get Minimal Console Time in Residency

Walker Julliard, MD1, John R Porterfield, MD2, Aurora D Pryor, MD3, Rachel R Kelz, MD, MSCE4, Gregory D Kennedy, MD, PhD1, Mary T Hawn, MD, MPH5, Brent D Matthews, MD6, Nathaniel J Soper, MD7, Jacob A Greenberg, MD, EdM1. 1University of Wisconsin, 2University of Alabama at Birmingham, 3Stony Brook University, 4University of Pennsylvania, 5Stanford University, 6Carolinas Healthcare System, 7Northwestern University

INTRODUCTION:  The objective of this survey study was to determine general surgery resident perceptions of robotic surgery.  Utilization of the robotic surgical system has increased dramatically for general surgery procedures over the past several years.  Many of these procedures are being performed at academic medical centers, yet the impact of the adoption of robotic surgery on resident training has not been assessed.

METHODS AND PROCEDURES:  A 20-item survey regarding perceptions of robotic surgery was distributed online to 261 general surgery residents enrolled in 7 University-based training programs. Data on demographics, case volume, current training environment, perceptions of robotic surgery and career goals were collected.  Quantitative and qualitative analyses were performed.

RESULTS:  There was a 41% response rate (n=108) among surveyed general surgery residents. Respondents were distributed across all years of clinical training (18% PGY1; 22% PGY2; 20% PGY3; 16% PGY4; 26% PGY5). All 7 training programs utilized the robot in general surgery.   The three most common robotic procedures performed by residents were proctectomy, colectomy, and cholecystectomy (71%, 43%, and 42% of residents performing these respectively). All respondents reported involvement in robotic procedures.  A minority of residents (33%) reported time spent operating the robotic console and the majority (67%) reported functioning as the bedside assistant.  Of those residents using the console, 53% felt that they had performed more than half of the case. This was greater than the reported extent of resident involvement in complex laparoscopic cases such as Heller myotomy (35% of residents completing >50% of the case, p=0.06), but less than the reported extent of resident involvement in basic laparoscopic cases such as cholecystectomy (70% of residents completing >50% of the case, p=0.053).  Most residents (63%) disagreed with the statement that they “would rather perform a robotic case over a laparoscopic case”; however, the majority of residents agreed that “it is important for me to receive training in robotic surgery” and felt that “robotic training needs to be a part of general surgery residency” (71 and 72% respectively).

CONCLUSIONS:  The utilization of robotic surgery is increasingly penetrating general surgery practice.  Residents are being exposed to robotic surgery at academic medical centers and recognize the importance of this training for their future practice. For the majority of residents, console time is limited.  Implementation of a robotic surgery curriculum could help ensure a meaningful training experience for residents.

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