Robotic Surgery Training Research Articles

Effects of automated skill assessment on robotic surgery training.

Several automated skill-assessment approaches have been proposed for robotic surgery, but their utility is not well understood. This article investigates the effects of one machine-learning-based skill-assessment approach on psychomotor skill development in robotic surgery training. N=29 trainees (medical students and residents) with no robotic surgery experience performed five trials of inanimate peg transfer with an Intuitive Surgical da Vinci Standard robot. Half of the participants received no post-trial feedback. The other half received automatically calculated scores from five Global Evaluative Assessment of Robotic Skill domains post-trial. There were no significant differences between the groups regarding overall improvement or skill improvement rate. However, participants who received post-trial feedback rated their overall performance improvement significantly lower than participants who did not receive feedback. These findings indicate that automated skill evaluation systems might improve trainee self-awareness but not accelerate early stage psychomotor skill development in robotic surgery training.

Assessment of students' satisfaction with virtual robotic surgery training

ObjectiveNowadays, in Bulgaria there is a trend of increasing entry into the surgical field of robot-assisted surgery operations, which suggests a need for the establishment of a large number of specialists in this field in a short period. Based on these arguments, the Medical University of Varna was the first university in the country to introduce a robotic surgery training program for medical students. The study aims to investigate the medical students’ satisfaction on robotic surgery training provided at Medical University of Varna with da Vinci Skills Simulator. DesignDuring the summer semester of the academic 2020/2021 and 2021/2022 years, a pilot training of robotic surgery was conducted with 5th year students in Medicine. Within one month, the students had the opportunity to get acquainted with the simulator of da Vinci Xi robotic system. The training was divided into two modules: a two-week theoretical module and a two-week practical module. After completing the training, students filled out a questionnaire dedicated to assess their satisfaction with the proposed training. Correlation between their responses and the objective parameters assessed on the simulator was calculated. ResultsThirty participants (16 men and 14 women) shared their opinion on easiness of use and usefulness of the robotic simulator in training of surgery activities. Students’ responses highly evaluated both aspects with average five-point Likert scale scores of 4.3 and 4.5, respectively. 93% of the participants would continue their further education and training in robotic surgery field. In addition, there was no correlation between objective evaluation by the simulator and students responses. ConclusionsTraining in robotic surgery proves to be a useful approach for training students to develop skills and profession in the field of surgery. The results suggest that training in this field may be accomplished even at the student level, by exploiting the robotic surgery in realistic scenario and thus, in a timely manner to find out the surgical direction they want to be further evolved.

The importance of robotic surgery training in HPB fellowship: A survey of the 2022 AHPBA fellows

Background: The indications for robotic surgery are expanding across all surgical subspecialties, including HPB. The incoming AHPBA fellows' experience with the surgical robot, and their perception of its utility in HPB surgery, remains variable and undefined.

Parallel, component training in robotic total mesorectal excision.

There has been widespread adoption of robotic total mesorectal excision (TME) for rectal cancer in recent years. There is now increasing interest in training robotic novice surgeons in robotic TME surgery using the principles of component-based learning. The aims of our study were to assess the feasibility of delivering a structured, parallel, component-based, training curriculum to surgical trainees and fellows. A prospective pilot study was undertaken between January 2021 and May 2021. A dedicated robotic training pathway was designed with two trainees trained in parallel per each robotic case based on prior experience, training grade and skill set. Component parts of each operation were allocated by the robotic trainer prior to the start of each case. Robotic proficiency was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and the EARCS Global Assessment Score (GAS). Three trainees participated in this pilot study, performing a combined number of 52 TME resections. Key components of all 52 TME operations were performed by the trainees. GEARS scores improved throughout the study, with a mean overall baseline score of 17.3 (95% CI 15.1-1.4) compared to an overall final assessment mean score of 23.8 (95% CI 21.6-25.9), p = 0.003. The GAS component improved incrementally for all trainees at each candidate assessment (p < 0.001). Employing a parallel, component-based approach to training in robotic TME surgery is safe and feasible and can be used to train multiple trainees of differing grades simultaneously, whilst maintaining high-quality clinical outcomes.

A systematic review of robotic surgery curricula using a contemporary educational framework.

There has been a rising trend in robotic surgery. Thus, there is demand for a robotic surgery curriculum (RSC) for training surgical trainees and practicing surgeons. There are limited data available about current curricular designs and the extent to which they have incorporated educational frameworks. Our aim was to study the existing robotic surgery curricula using Kern's 6-step approach in curriculum development. A systematic review was conducted using PubMed, PubMed Central, Cochrane, Embase, and Scopus (we searched studies from 2001 to 2021). PRISMA Guidelines was used to guide the search. Curriculum designed for general surgery and its subspecialties were included. Urology and gynecology were excluded. The articles were reviewed by five reviewers. Our review yielded 71 articles, including 39 curricula at 9 different settings. Using Kern's framework, we demonstrated that the majority of robotic surgery curricula contained all the elements of Kern's curricular design. However, there were significant deficiencies in important aspects of these curricula i.e., implementation, the quality of assessment tools for measurement of performance and evaluation of the educational value of these interventions. Most institutions used commercial virtual reality simulators (VRS) as the main component of their RSC and 23% of curricula only used VRS. Although majority of these studies contained all the elements of Kern's framework, there are critical deficiencies in the components of existing curricula. Future curricula should be designed using established educational frameworks to improve the quality of robotic surgery training.

Cost analysis of training residents in robotic-assisted surgery.

Use of robotic-assisted surgery is increasing, and resident involvement may lead to higher costs. We investigated whether senior resident involvement in noncomplex robotic cholecystectomy (RC) and inguinal hernia (RIH) would take more time and cost more when compared to non-robotic cholecystectomy (NRC) and inguinal hernia repair (NRIH). We extracted surgery duration and total cost of NRC, NRIH, RC, and RIH from 7/2016 to 6/2020 with senior resident (PGY4-5) involvement. We excluded complex cases as well as prisoner cases and those with new faculty and research residents. We assessed differences between robotic and non-robotic cases in surgery duration and total cost per minute, using one-way ANOVA. We included 1608 cases (non-robotic 1145 vs. robotic 463). On average, RC cases with a senior resident took less time than NRC (179.4 < 185.8, p = 0.401); surgery duration of RIH cases was similar with NRIH cases. The total cost per minute of RC cases with a senior resident on average was $9.30 higher than NRC cases for each minute incurred in the operating room but did not lead to a significant change in overall cost. RIH cases, on the other hand, cost less per minute than NRIH cases (114.1 < 126.5, p = 0.399). Training in robotic surgery is important. Noncomplex RC and RIH involving senior residents were not significantly longer nor did they incur significantly more cost than non-robotic procedures. Senior resident training in noncomplex robotic surgery can be efficient and can be included in the residency curriculum.

Developing a Robotic Surgery Curriculum: Selection of Virtual Reality Drills for Content Alignment

IntroductionDespite the importance of simulation-based training for robotic surgery, there is no consensus about its training curricula. Recently, a virtual reality (VR) platform (SimNow, Intuitive, Inc) was introduced with 33 VR drills but without evidence of their validity. As part of our creating a new robotic VR curriculum, we assessed the drills’ validity through content mapping and the alignment between learning goals and drill content. MethodsThree robotically trained surgeons content-mapped all 33 drills for how well the drills incorporated 15 surgery skills and also rated the drills’ difficulty, usefulness, relevance, and uniqueness. Drills were added to the new curriculum based on consensus about ratings and historic learner data. The drills were grouped according to similar skill sets and arranged in order of complexity. ResultsThe 33 drills were judged to have 12/15 surgery skills as primary goals and 13/15 as secondary goals. Twenty of the 33 drills were selected for inclusion in the new curriculum; these had 11/15 skills as primary goals and 11/15 as secondary goals. However, skills regarding energy sources, atraumatic handling, blunt dissection, fine dissection, and running suturing were poorly represented in the drills. Three previously validated inanimate drills were added to the curriculum to address lacking skill domains. ConclusionsWe identified 20 of the 33 SimNow drills as a foundation for a robotic surgery curriculum based on content-oriented evidence. We added 3 other drills to address identified gaps in drill content.

Multidisciplinary perceptions on robotic surgical training: the robot is a stimulus for surgical education change.

It is unclear how to best establish successful robotic training programs or if subspecialty robotic program principles can be adapted for general surgery practice. The objective of this study is to understand the perspectives of high-volume robotic surgical educators on best practices in robotic surgery training and to provide recommendations transferable across surgical disciplines. This multi-institutional qualitative analysis involved semi-structured interviews with high-volume robotic educators from academic general surgery (AGS), community general surgery (CGS), urology (URO), and gynecology (GYN). Purposeful sampling and snowballing ensured high-volume status and geographically balanced representation across four strata. Interviews were transcribed, deidentified, and independently, inductively coded. A codebook was developed and refined using constant comparative method until interrater reliability kappa reached 0.95. A qualitative thematic, framework analysis was completed. Thirty-four interviews were completed: AGS (n = 9), CGS (n = 8), URO (n = 9), and GYN (n = 8) resulting in 40 codes and four themes. Theme 1: intangibles of culture, resident engagement, and faculty and administrative buy-in are as important as tangibles of robot and simulator access, online modules, and case volumes. Theme 2: robotic OR integration stresses the trainee-autonomy versus patient-safety balance. Theme 3: trainees acquire robotic skills along individual learning curves; benchmark assessments track progress. Theme 4: AGS can learn from URO and GYN through multidisciplinary collaboration but must balance pre-existing training program use with context-specific curricular needs. Robotic surgical experts emphasize the importance of universal training paradigms, such as a strong educational culture that balances autonomy and patient safety, collaboration between disciplines, and routine assessments for continuous growth. Often, introduction and acceptance of the robot serves as a stimulus to discuss broader surgical education change.

Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a randomised, prospective, cross-over, effectiveness study

Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. The virtual classroom is comprised of a studio with multiple audio–visual inputs to which participants can connect remotely via the BARCO weConnect platform. Eleven novice surgical trainees were randomly allocated to two training groups (A and B). In week 1, both groups completed a robotic skills induction. In week 2, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week 3, the groups received the alternate intervention. The primary outcome was measured using the validated robotic-objective structured assessment of technical skills (R-OSAT) at the end of week 2 (time-point 1) and 3 (time-point 2). All participants completed the training curriculum and were included in the final analyses. At time-point 1, Group A achieved a statistically significant greater mean proficiency score compared to Group B (44.80 vs 35.33 points, p = 0.006). At time-point 2, there was no significant difference in mean proficiency score in Group A from time-point 1. In contrast, Group B, who received further adjunctive VCT showed significant improvement in mean proficiency by 9.67 points from time-point 1 (95% CI 5.18–14.15, p = 0.003). VCT is an effective, accessible training adjunct to self-directed robotic skills training. With the steep learning curve in robotic surgery training, VCT offers interactive, expert-led learning and can increase training effectiveness and accessibility.

Training in the protocol for robotic undocking for life emergency support (RULES) improves team communication, coordination and reduces the time required to decouple the robotic system from the patient.

Robotic surgery has expanded on it's surgical application and it is also noted an increase in surgical procedures complexity. Occurrence of emergency situations that require conversion of the minimally invasive access route to open access routes is uncommon. The urgent undocking of the robotic platform is a complex and neglected process in robotic surgery training. To establish specific actions and comands for a safe emergency robotic undocking in a simulation environment. Two surgical teams, interventional group (IG) and control group (CG), were submitted to a simulation environment in which there was a need for emergency undocking of the robotic system. The intervention group underwent training with the robotic undocking for life emergency support (RULES) protocol. Undocking time of the robotic platform from the IG was reduced by 66% and the CG by only 20%. After RULES protocol training, during the second simulation, the IG acquired more critical actions necessary for emergency undocking and developed more non-technical skills. The RULES protocol proved to be effective, promoting an improvement in technical and non-technical skills of all surgical team menbers, resulting in more effective actions that resut in a coordinated and faster robotic undocking. It is also concluded that the surgeon and bed side surgeon are the key elements for the efficient robotic system undocking in emergency situations.

291 Virtual Classroom Proficiency-Based Progression for Robotic Surgery Training (VROBOT): A Prospective, Cross-Over, Effectiveness Study

Abstract Aim Robotic surgical training has historically lacked evidence-based standardisation. The Fundamentals of Robotic Surgery (FRS) curriculum addresses this by incorporating proficiency-based modules which certify trainees’ skills. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtual classroom training (VCT) as an adjunct to the FRS curriculum for robotic skills training. Method 11 novice surgical trainees were randomly allocated to two groups. Both groups completed a one-week robotic skills induction. In week two, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week three, the groups received the alternate intervention. The primary outcome was measured using the validated robotic-objective structured assessment of technical skills (R-OSAT). Results 11 participants completed the training curriculum; all were included in analyses. Both groups demonstrated significantly improved proficiency upon completion of the training. At time point 1 (end of week two) Group A achieved a statistically significant greater mean proficiency score compared to Group B (44.80 vs 35.33 points, p=0.006). At time point 2 (end of week three), there was no significant difference in Group A's mean score from time point 1. In contrast, Group B showed significant improvement in mean proficiency by 9.67 points from time point 1 (95% CI 5.18–14.15, p=0.003). Conclusions VCT is an effective training adjunct to the FRS curriculum for the learning of basic robotic skills. With the steep learning curve in robotic surgery training, VCT offers interactive learning and can increase training effectiveness.

SP7.1 Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a prospective, cross-over, effectiveness study

Abstract Aims Robotic surgery is an evolving surgical technique, requiring specialist training. The standardised Fundamentals of Robotic Surgery (FRS) curriculum incorporates proficiency-based modules to certify the skills of novice trainees. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtual classroom training (VCT) in concordance with the FRS for robotic skills training. Methods 11 novice surgical trainees were randomly allocated to two training groups. Both groups completed a one-week robotic skills induction. In week two, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week three, the groups received the alternate intervention. The primary outcome was measured using the validated R-OSAT score. This was collected post-intervention at time point 1(end of week two) and time point 2(end of week three). Results Participants attained higher mean proficiency scores with both the FRS curriculum and VCT, compared to the FRS curriculum alone. At timepoint 1, Group A achieved a greater mean proficiency score compared to Group B (44.80 vs 35.33, p=0.006). At timepoint 2, there was no significant difference in mean proficiency score in Group A from timepoint 1. In contrast, Group B, who received adjunctive VCT showed significant improvement in mean proficiency by 9.67points from timepoint 1 (95% CI 5.18–14.15, p=0.003). Conclusion VCT is an effective training adjunct to the FRS curriculum for learning basic robotic skills. With the steep learning curve in robotic surgery training, VCT offers interactive learning and can increase training effectiveness and accessibility.

P18 Assessment of da Vinci robotic system for paediatric laparoscopic procedures

Abstract Introduction We aimed to evaluate the da Vinci surgical system in its application for robotic-assisted laparoscopic surgery in paediatric patients. Methods A narrative review of the literature on the use of this technology was performed following ENTREQ guidelines using PubMed/Medline, EMBASE, and Google Scholar databases with no setting or language restrictions. Results A total of 16 publications were selected for inclusion. Although the literature on the accuracy and precision of this technology are encouraging, its use in paediatric patients are still in its early stages and has yet to be explored in great detail. In addition to the technical intricacies, training and learning curve, port placement complications, cost, we identified concerning shortcomings including its bulkiness and lack of force feedback, which lead to procedural injuries notably, tearing of muscles, blood vessels, and nerves, as well as surgical error. For both, we propose sensory haptic feedback systems, soft tissue model, image-guided or virtual reality simulation training to reduce these injury-related complications. However, this does not replace the necessity for “supervised trial and error” operation of the robotic system in surgical settings. Conclusion Innovations in educational training for robotic surgery include tele-presence surgeries and robotic tele- mentoring, whereby expert surgeons share the same surgical field of view and controls as the training surgeon. In spite of this, there are inevitable risks associated with training when training surgeons must practice through trial and error on real patients and an emphasis must be placed on apposite pre-procedural surgical training. Take-home message Though promising, the use of the Da Vinci robotic system in children is still emerging and thus warrants further evaluation, training, and development prior to its routine implementation for use.

Enabling 4-DoF hand guidance using a portable haptic device exerting tangential force on the user's finger pads

Body-grounded kinesthetic haptic devices can provide cues for movement in multiple degrees of freedom by exerting forces directly on users, as in dexterous robot teleoperation tasks. However, these haptic devices have limited workspaces, can destabilize a teleoperation control loop, and can be expensive. Portable haptic devices can approximate the sensations of a kinesthetic device by exploiting diverse human sense of touch principles without these shortcomings. Our goal is to analyze the feasibility of hand guidance (HG) using tangential force stimuli. Here we reveal and quantify users’ interpretation of simultaneous tactile stimulation (STS) applied to multiple finger pads of the same hand. We completed an extensive experiment on different users to reveal a maximum number of understandable cues which can be used as movement commands for HG. As expected, many tactile stimuli tested were meaningless for users, but a few could be clearly interpreted — we call these “intuitive movement cues”. For the experiment, we designed a device that can be held in the palm and exerts tactile stimuli to the user's finger pads on the thumb and index fingers, or the thumb and middle fingers. We performed two studies in which we identified the extent of salience of different movement cues. In particular, commands to redirect the hand position and orientation in four axes: moving forward/backward, wrist twisting right/left (rotate clockwise/counter-clockwise), moving right/left, and wrist tilting up/down (rotate upwards/downwards). The results revealed that this approach provided 7 intuitive directional movement cues for relative HG in 3D space. The proposed HG principle is promising for applications such as robotic surgery training, laparoscopic training, and needle insertion training, during which surgical trainees must learn dexterous hand movements involving motion paths. There are many applications for 3D movement guidance outside the medical domain that could benefit from this haptics technology, including training for precise manipulation and assembly tasks, augmented teleoperation, and communication during shared control in collaborative human-machine systems.

Should Robotic Surgery Training Become a General Surgery Residency Requirement? A National Survey of Program Directors in Surgery

Robotic-assisted surgery (RAS) accounts for 15% of general surgery (GS) operations performed and is set to grow in prevalence. Currently, there are no training requirements or standard robotic curricula for GS residents. This study aimed to query GS program directors (PDs) on the necessity, extent, and potential impact of including RAS as a required component of residency training. Analysis of responses to a 14-question web-based survey. Survey was distributed to PDs via the Association of Program Directors in Surgery listserv in April and May 2021. General surgery program directors RESULTS: Among 140 respondents, 110 (78.6%) agreed that operating at the robotic console should be a GS residency requirement, yet 93 (66.4%) indicated that RAS exposure negatively impacts the acquisition of other necessary skills. Still, 116 (82.9%) agreed that RAS training provided a net benefit to GS residents, PDs at academic programs were more supportive than those at independent programs of RAS console training requirements (68.2% versus 46.7%, p = 0.048). The median response to the ideal proportion of abdominopelvic cases performed by graduation was 20% robotic, 40% laparoscopic, and 35% open. The suggested minimum number of robotic cases that should be performed by graduation was indicated to be 30 cases by 26% of respondents, 20 by 23%, 10 by 12%, 5 by 4%, and "no minimum" by 36%. There is strong interest among PDs to institute RAS training requirements for GS residents. This study provides PD perspectives to help inform national conversations on whether and to what extent RAS requirements should be included in GS residency training.

Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial.

Robotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills. We conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2. Sixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p &lt; 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group. There was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.

Model Development of a Novel Robotic Surgery Training Exercise With Electrocautery

Robot-assisted surgery (RAS) has undergone rapid adoption in general surgery due to features such as three-dimensional visualization, wrist dexterity, improved precision of movement, and operator ergonomics. While many surgical trainees encounter RAS during their residency, robotic skills training programs and curricula vary across institutions and there is broad variation in graduating general surgeons’ robotic proficiency levels. Due to a need for a formalized process to achieve competence on the robotic platform, simulation-based training has become instrumental in closing this gap as it provides training in a low-stakes environment while allowing the trainee to improve their psychomotor and basic procedural skills.Several different models of simulation training exist including virtual reality, animal, cadaveric, and inanimate tissue platforms. Each form of training has its own merits and limitations. While virtual reality platforms have been well evaluated for face, content, and construct validity, their initial set-up costs can be as high as $125,000. Similarly, animal and cadaveric models are not only costly but also have ethical considerations that may preclude participation. There is an unmet need in developing high-fidelity, cost-effective simulations for basic videoscopic skills such as cautery use.We developed a cost-effective and high-fidelity inanimate tissue model that incorporates electrocautery. Using a double-layered bowel model secured to a moistened household sponge, this inanimate exercise simulates fundamental skills of robotic surgery such as tissue handling, camera control, suturing, and electrocautery.

Effect of prostate and bony pelvic dimensions measured by preoperative magnetic resonance imaging on robot-assisted radical prostatectomy.

Bone pelvic dimensions and body habitus may have effects on robot-assisted radical prostatectomy (RARP). In this study, we examined the effects of body mass index, bone pelvis measurements and prostate measurements on console time (CT), decrease in postoperative hemogram level (DHL) and surgical margin(SM) in patients who underwent RARP for clinically localized prostate cancer in our institution. The data of transperitoneal RARP cases performed by a single surgeon between November 2016 and August 2020 were analyzed retrospectively. It was included in 125 patients who met the study criteria. Bone and soft tissue measurements were made on magnetic resonance imaging T2-weighted imaging in the mid-sagittal and transvers plane. In multivariate linear regression analyzes, only soft tissue width/transverse diameter of the prostate and CT were found to be correlated (p = 0.026). For the DHL, no pelvic dimension and body habitus had a significant association on multivariate linear regression analysis. In multivariate analyzes, a statistically significant difference was found only between pathological Gleason Score and SM (p = 0.008). Although we found statistically significant associations between prostate diameters and pelvic bone measurements and operative difficulties, we believe that further studies are needed to confirm these results. Such information can help identify patients with challenging anatomy and can be used in robotic surgery training to achieve optimal patient outcomes after RARP.

The Atlantic divide: contrasting surgical robotics training in the USA, UK and Ireland

The uptake of robotic surgery is rapidly increasing worldwide across surgical specialties. However, there is currently a much higher use of robotic surgery in the United States of America (USA) compared to the United Kingdom (UK) and Ireland. Reduced exposure to robotic surgery in training may lead to longer learning curves and worse patient outcomes. We aimed to identify whether any difference exists in exposure to robotic surgery during general surgical training between trainees in the USA, UK and Ireland. Over a 15-week period from September 2021, a survey was distributed through the professional networks of the research team. Participants were USA, UK or Irish trainees who were part of a formal general surgical training curriculum. 116 survey responses were received. US trainees (n = 34) had all had robotic simulator experience, compared to only 37.93% of UK (n = 58) and 75.00% of Irish (n = 24) trainees (p < 0.00001). 91.18% of US trainees had performed 15 or more cases as the console surgeon, compared to only 3.44% of UK and 16.67% of Irish trainees (p < 0.00001). Fifty UK trainees (86.21%) and 22 Irish trainees (91.67%) compared to 12 US trainees (35.29%) do not think they have had adequate robotics training (p < 0.00001). Surgical trainees in the USA have had significantly more exposure to training in robotic surgery than their UK and Irish counterparts.

Robotic cardiac surgery training during residency: Preparing residents for the inevitable future

Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skill training is minimal or absent in residency curricula. A review was conducted to identify residents' exposure to robotic cardiac surgery training based on databases including PubMed, MEDLINE and Google Scholar. Published papers and cardiothoracic surgical societies with robotic cardiac surgery training courses were reviewed. Robotic cardiac surgery training for residents is almost non-existent. Strategies to establish proper robotic cardiac surgical training for residents include implementing simulation training, implementing hour requirements and establishing wet/dry lab model training in a progressive fashion. As robot-assisted cardiac surgery becomes increasingly commonplace, it will be imperative to provide training for residents with dedicated opportunities to develop their skills in robotic cardiac surgery.