Robotic Hernia Curriculum Improves Resident Performance on Inguinal and Ventral Hernias

Abstract

INTRODUCTION: Hernia repairs are one of the most common procedures performed in general surgery. The widespread incorporation of the robotic approach in this procedure warrants the presence of a proficiency-based curriculum to assist novice surgeons in credentialing and safe implementation. This study evaluates the construct validity of a robotic hernia curriculum in a cohort of general surgery residents. METHODS: PGY3 general surgery residents were asked to complete four inguinal hernia (IHR) and four ventral hernia (VHR) drills. These were graded according to the modified objective structured assessment of technical skills (OSATS) by two independent blinded graders in addition to drill time. The hernia drills were completed by three attending surgeons establishing gold standard benchmarks. RESULTS: 20 residents started the curriculum, 19 completed all IHR and 17 completed all VHR. Attending total OSATS scores and times were significantly better than those of the trainees on first attempt (p < 0.05). When comparing the 4th to the 1st attempts for residents, OSATS scores improved significantly for IHR (15.5 vs 23.3, p < 0.001) and VHR (16.8 vs 23.3, p<0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 mins, p < 0.001 and VHR: 29.6 vs 21.2 mins, p < 0.001). Residents were able to achieve attending scores by their fourth attempt for VHR, but not for the IHR (Fig. 1). Residents were not able to achieve attending times for either hernia drill after four attempts.Figure 1CONCLUSION: The robotic hernia curriculum improves resident performance. More procedure specific curricula are needed to better prepare trainees for the operating room.