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The evolution of the general surgery resident operative case experience in the era of robotic surgery

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotic-assisted general surgery procedures are becoming commonplace, requiring more residency programs to establish training curricula for residents. Concerns exist regarding the impact this will have on surgical residents’ operative case distribution in laparoscopic and open surgery. This study aimed to analyze the impact of a growing robotic operative case volume and established robotic surgery training curriculum on the general surgery resident operative experience.

Methods

The robotic surgery training curriculum at the Medical College of Wisconsin was established in 2017. ACGME operative case logs of residents from 2014 to 2020 were analyzed to determine resident participation in open, laparoscopic, and robotic cases. Case categories included alimentary tract, abdomen, endocrine, thoracic, pediatric, and trauma. A one-way analysis of variance (ANOVA) was used to analyze overall cases, as well as participation by case type, post-graduate year (PGY) level, resident role, and institution type. Statistical significance was defined as a p value < 0.05.

Results

Operative case logs from 77 residents were analyzed with a total of 34,757 cases: 59.3% open, 39.6% laparoscopic, and 1.1% robotic. There was no significant change in open or laparoscopic case volumes. However, there was a 3.4% increase in robotic cases, from 2014 to 2020 (p = 0.01), specifically in foregut (4.0%, p = 0.01), intestinal (1.6%, p = 0.03), and hernia (8.3%, p = 0.003) procedures. Academic (2.8%, p = 0.01) and veterans’ hospital (2.0%, p = 0.01) institutions saw a significant increase in their residents’ robotic cases. The only resident role with a significant increase in robotic cases was first assistant (8.0%, p = 0.004). There was no significant difference across PGY levels by surgical approach.

Conclusions

This study highlights that the growth of robotic cases has not had a detrimental effect on the resident experience with open and laparoscopic cases. As robotic cases continually increase, the impact on laparoscopic and open case volumes must be monitored to ensure a well-balanced training experience.

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Authors and Affiliations

  1. Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Nnenna S. Nwaelugo, Matthew I. Goldblatt, Jon C. Gould & Rana M. Higgins

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  1. Nnenna S. Nwaelugo
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  2. Matthew I. Goldblatt
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  3. Jon C. Gould
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  4. Rana M. Higgins
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Correspondence to Rana M. Higgins.

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Disclosures

Nnenna Nwaelugo has no disclosures to report. Dr. Jon Gould is a consultant for Ethicon, WL Gore, and BD. Dr. Matthew Goldblatt has the following disclosures: Speaking and consulting for W.L. Gore; Speaking, consulting, and research for Medtronic; and Research for Bard. Dr. Rana Higgins is a speaker for WL Gore and Intuitive Surgical.

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Nwaelugo, N.S., Goldblatt, M.I., Gould, J.C. et al. The evolution of the general surgery resident operative case experience in the era of robotic surgery. Surg Endosc 36, 6679–6687 (2022). https://doi.org/10.1007/s00464-021-08940-x

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  • DOI: https://doi.org/10.1007/s00464-021-08940-x

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