Offering robotic surgical education during general surgery residency

Ankit Patel, MD¹, Jamil Stetler, MD¹, Jay Singh, MD², Jahnavi Srinivasan, MD¹, Keith Delman, MD¹, John Sweeney, MD¹, S. Scott Davis, MD¹, Edward Lin, DO¹. ¹EMORY UNIVERSITY, ²Piedmont Colorectal Associates

Background: There has been a significant growth in robotic surgery in the field of general surgery in the past few years. Many residency programs, especially in urology and gynecology, have attempted to incorporate training into their curriculum but struggled to standardize the process, forcing many residents to seek additional training or fellowships. Several surgical subspecialties, such as cardiothoracic, pediatrics, colorectal, oncology, and minimally invasive, enroll their fellows into training courses.  In general surgery residency programs, formal training exists for laparoscopy and robotics is a natural extension of this skill set. We illustrate a training model for residents during their general surgery residency to achieve proficiency that would allow them to perform robotic surgery without any further training.

Methods: We began by examining the training provided by Intuitive Surgical to prospective surgeons interested in robotic surgery. In 2013, they developed an equivalency certificate that could be obtained by fellows during their training as long as they met the minimal criteria. We expanded on these minimal guidelines and incorporated prior published data on simulator training and skill sets needed to perform robotic surgery safely to develop a curriculum that would measure not only performance during a case, but also develop knowledge about troubleshooting and safety for the patient. The curriculum consists of the following: 1) reviewing online modules designed for the surgeon as well as the assistant, 2) completing 14 simulator exercises that are critical for energy application, camera manipulation, economy in range of motion, and needle handling, 3) hands-on course designed by the surgical staff, 4) minimum of 10 cases as bedside assistant, and 5) minimum of 20 cases as console surgeon. The last 5 cases were discussed pre/postoperatively, recorded, and reviewed by current robotic general surgery faculty.

Results: Since 2013, 6 minimally invasive fellows have completed the requirements and graduated with the equivalency certificate. Of the 6 MIS fellows, 2 are in academic practices and currently train residents in robotics. 3 of the other 4 fellows are successful robotic leaders in their private practice groups. In addition, 3 residents also completed the requirements and did not require any formal training during their fellowships. All of the participants showed improvement in operative times and overall performance during their 5 cases.

Conclusion: Formalized training needs to exist for robotic surgery and can safely be incorporated into residency training, especially for those interested in robotic surgery.