Abstract
Background
There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents’ learning curve and skill transference within the two minimally invasive platforms.
Methods
General surgery residents were observed during the performance of laparoscopic and robotic inguinal hernia repairs. The recorded data included objective measures (operative time, resident participation indicated by percent active time on console or laparoscopy relative to total case time, number of handoffs between the resident and attending), and subjective evaluations (preceptor and trainee assessments of operative performance) while controlling for case complexity, patient comorbidities, and residents’ prior operative experience. Wilcoxon two-sample tests and Pearson Correlation coefficients were used for analysis.
Results
Twenty laparoscopic and forty-four robotic cases were observed. Mean operative times were 90 min for robotic and 95 min for laparoscopic cases (P = 0.4590). Residents’ active participation time was 66% on the robotic platform and 37% for laparoscopic (P = < 0.0001). On average, hand-offs occurred 9.7 times during robotic cases and 6.3 times during laparoscopic cases (P = 0.0131). The mean number of cases per resident was 5.86 robotic and 1.67 laparoscopic (P = 0.0312). For robotic cases, there was a strong correlation between percent active resident participation and their prior robotic experience (r = 0.78) while there was a weaker correlation with prior laparoscopic experience (r = 0.47). On the other hand, prior robotic experience had minimal correlation with the percent active resident participation in laparoscopic cases (r = 0.12) and a weak correlation with prior laparoscopic experience (r = 0.37).
Conclusion
The robotic platform may be a more effective teaching tool with a higher degree of entrustability indicated by the higher mean resident participation. We observed a greater degree of skill transference from laparoscopy to the robot, indicated by a higher degree of correlation between the resident’s prior laparoscopic experience and the percent console time in robotic cases. There was minimal correlation between residents’ prior robotic experience and their participation in laparoscopic cases. Our findings suggest that the learning curve for the robot may be shorter as prior robotic experience had a much stronger association with future robotic performance compared to the association observed in laparoscopy.
Similar content being viewed by others
References
Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P (2021) Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg 273(5):858–867. https://doi.org/10.1097/SLA.0000000000004466
Lee J, Kim YM, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29(11):3251–3260. https://doi.org/10.1007/s00464-015-4069-1
Park JM, Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Hyung WJ, Ryu KW (2016) Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy. Eur J Surg Oncol 42(12):1944–1949. https://doi.org/10.1016/j.ejso.2016.07.012
Tom CM, Maciel JD, Korn A, Ozao-Choy JJ, Hari DM, Neville AL, de Virgilio C, Dauphine C (2019) A survey of robotic surgery training curricula in general surgery residency programs: how close are we to a standardized curriculum? Am J Surg 217(2):256–260. https://doi.org/10.1016/j.amjsurg.2018.11.006
Madion MP, Kastenmeier A, Goldblatt MI, Higgins RM (2022) Robotic surgery training curricula: prevalence, perceptions, and educational experiences in general surgery residency programs. Surg Endosc 36(9):6638–6646. https://doi.org/10.1007/s00464-021-08930-z
Carpenter BT, Sundaram CP (2017) Training the next generation of surgeons in robotic surgery. Robotic Surg (Auckland) 4:39–44. https://doi.org/10.2147/RSRR.S70552
Porras Rodriguez P, Kapadia S, Moazzez A, Singer G, Neville A, Yetasook A, Dauphine C (2022) Should robotic surgery training become a general surgery residency requirement? A national survey of program directors in surgery. J Surg Educ 79(6):e242–e247. https://doi.org/10.1016/j.jsurg.2022.06.010
Fundamentals of Laparoscopic Surgery. https://www.flsprogram.org/. Accessed 10 Feb 2024
Obek C, Hubka M, Porter M, Chang L, Porter JR (2005) Robotic versus conventional laparoscopic skill acquisition: implications for training. J Endourol 19(9):1098–1103. https://doi.org/10.1089/end.2005.19.1098
Kanitra JJ, Khogali-Jakary N, Gambhir SB, Davis AT, Hollis M, Moon C, Gupta R, Haan PS, Anderson C, Collier D, Henry D, Kavuturu S (2021) Transference of skills in robotic vs laparoscopic simulation: a randomized controlled trial. BMC Surg. https://doi.org/10.1186/s12893-021-01385-y
Meyerson SL, Sternbach JM, Zwischenberger JB, Bender EM (2017) Resident autonomy in the operating room: expectations versus reality. Ann Thorac Surg 104(3):1062–1068. https://doi.org/10.1016/j.athoracsur.2017.05.034
Fryer JP, Teitelbaum EN, George BC, Schuller MC, Meyerson SL, Theodorou CM, Kang J, Yang A, Zhao L, DaRosa DA (2018) Effect of ongoing assessment of resident operative autonomy on the operating room environment. J Surg Educ 75(2):333–343. https://doi.org/10.1016/j.jsurg.2016.11.018
Ranney SE, Bedrin NG, Roberts NK, Hebert JC, Forgione PM, Nicholas CF (2021) Maximizing learning in the operating room: residents’ perspectives. J Surg Res 263:5–13. https://doi.org/10.1016/j.jss.2021.01.013
Lees MC, Zheng B, Daniels LM, White JS (2019) Factors affecting the development of confidence among surgical trainees. J Surg Educ 76(3):674–683. https://doi.org/10.1016/j.jsurg.2018.10.016
Quinn KM, Chen X, Griffiths C, Chen G, Osayi S, Husain S (2023) Skill transference and learning curves in novice learners: a randomized comparison of robotic and laparoscopic platforms. Surg Endosc 37(11):8483–8488. https://doi.org/10.1007/s00464-023-10486-z
Acknowledgements
No acknowledgments.
Funding
This work was funded by a SAGES Intuitive Surgical Robotic Surgery Grant 2018.
Author information
Authors and Affiliations
Contributions
All authors attest that they meet the current ICMJE criteria for Authorship.
Corresponding author
Ethics declarations
Disclosures
Syed Husain was supported by SAGES Intuitive Robot Surgery Grant for this work. Michael Meara is supported by SAGES Intuitive Training and Education Grant. Kristen Quinn, Louis Runge, Claire Griffiths, Heidi Pieper, Hannah Harris, Ben Poulose, Vimal Narula, David Renton, Courtney Collins, and Alan Harzman have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Quinn, K.M., Runge, L.T., Griffiths, C. et al. Laparoscopic vs robotic inguinal hernia repair: a comparison of learning curves and skill transference in general surgery residents. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10860-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00464-024-10860-5