Importance of Robotic Training Curriculum for the Surgical Oncologist: Direct Correlation Between Robotic Training and Current Use of Robotics.

Federico Tozzi, Sinziana Dumitria, MD, MScEpi, Micheal White, MD, Byrne Lee, MD, Leanne Goldstein, Gagandeep Singh, MD, Yuman Fong, MD, Yanghee Woo, MD. City of Hope – National Cancer Center

Introduction: More than 10,000 robotic assisted cases have been completed since the inception of the first surgical robotic system at our National Comprehensive Cancer Center training hospital. The adoption of robotic surgery has consequently exposed the surgical oncology trainees to this technology during fellowship training.  We propose to understand the impact of robotic surgery exposure during training on the current practice of past-fellows.

Methods: Participation in robotic operations by surgical oncology fellows was retrospectively analyzed from the institutional robot database from 2003 to 2014. A Web-based questionnaire with volunteer participation was distributed electronically to surgical oncologists who trained at this institution. Categorical, ordinal and continuous variable questions were created to obtain the current practice, level of exposure to robotic training and the integration of this technology once in practice. Robotic exposure score was calculated for each participant.  We used descriptive and inferential statistics to analyze and correlate the responses to the database.

Results: The survey was completed by 83% of the past-fellow. There is a direct correlation between in-training exposure and the future use of robotics (r=0.9997). The exposure scores were significantly higher among robot adopters vs. non-adopters (mean 17.0 vs 13.6, p=0.05) according to the online survey.  Of the survey responders, 60% adopted robotic technology in their current practice. The primary application is in colorectal (38%), pancreas (22%), foregut (22%), and liver (13%) surgery. The in-training exposure was in colorectal (38.5%), gynecology (30.5%) and thoracic surgery (20%). Robot adopters were more likely to perceive robotic surgery training during fellowship as adequate compared to their counterparts (Percentage agree 40% vs 20%. Z-score%: 57% vs 80%). Additionally, 60% of robot adopters did not pursued further training after completion of their fellowship.

Conclusions:  Surgical robotic exposure during fellowship training has a significant positive impact on the adoption of robotic technology once in practice. In addition to gastrointestinal operations, gynecology and thoracic surgery also provided a substantial contribution to robotics training during fellowship. Even if the fellowship robotic training was perceived as suboptimal by adopter and non-adopter, the majority of robot adopters did not pursue further robotic training after completing fellowship. This study confirms the need to develop a standardized curriculum in robotic surgery during fellowship that includes gynecology and thoracic surgery tailored to the trainees’ interests and needs.