Robotic Skills Assessment: Crowd-Sourced Evaluation in Surgery and Future Directions in Plastic Surgery

Abstract

Surgical technique is paramount in achieving desirable surgical outcomes. This statement holds true across all surgical disciplines, including plastic, urologic, and gynecologic surgery. Currently, surgical skills acquisition during training in several subspecialties (including plastic surgery and urology) is graded in accordance with the ACGME’s (Accredited Council of Graduate Medical Education) milestone projects. This method of assessment is predicated upon the subjective evaluation of individual observers. Thus, significant potential for observer bias exists in these systems. Furthermore, at most hospitals in the United States, the credentialing process is based upon peer recommendations or case currency. These methods result in a system of assessment that lacks in efficiency, cost-effectiveness, and standardization. The creation of structed tools for the assessment of surgical skill, such as Objective Structured Assessment of Technical Skills (OSATS), provided a framework to produce validated assessments of technical skill. OSATS provided a set of parameters by which many types of surgery could be analyzed on their technical merits. However, while a validated system of assessment, grading a surgeon using systems such as OSATS is often a time-consuming and resource-intensive process – still performed by individual expert surgeons with all the associated costs. As such, these methods have been adopted only within certain subfields where they can be deployed in an efficient manner. Currently, within plastic and reconstructive surgery, few of these methods have been adopted. This chapter presents the current use of a crowd-sourced platform for surgical skills assessment – the Crowd-Sourced Assessment of Technical Skill (CSATS). The platform has successfully been applied to several procedures in both robotic and endoscopic urologic and general surgery. This novel platform of surgical assessment provides a cost-effective, timely, and validated method of surgical skills assessment. While the platform has not been widely adopted within plastic surgery, the authors point to possible opportunities for an analogous system used by plastic surgeons.