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Integration of Robotics in Urology Residency Programs: an Unchecked Technological Revolution

  • Education (G Badalato and E Margolin, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the integration of robotics in urology residency programs and evaluate how it has impacted a graduates’ level of surgical competence.

Recent Findings

Surgical technique training has shown a dramatic shift towards robotics with the most profound occurring in oncology. However, integration of robotics is not uniform across programs nor even among residents themselves. Robotics require graduates to garner a broader skill set within the same prescribed training time. Unfortunately, in this modern era, graduates are feeling more ill-equipped to start independent practice and show an increased need to pursue fellowship training to achieve technical proficiency.

Summary

The dissemination of robotics in residency programs has gone unchecked. Modulating existing training structures through (1) development of procedure- and surgical technique-specific target metrics for graduation and (2) integration of a formalized robotic curriculum may improve the overall quality and outcome of the educational experience.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. George EI, Brand CT. Origins of robotic surgery: from skepticism to standard of care. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2018;22(4).

  2. • Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3(1):e1918911-. A large scale cohort evaluating the trends of surgical technique, confirming a rapid and persistent increase in robotic surgery as well as a decrease in both laparoscopic and open surgeries.

  3. Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: a systematic review and meta-analysis. Medicine. 2019;98(22).

  4. Childers CP, Maggard-Gibbons M. Estimation of the acquisition and operating costs for robotic surgery. JAMA. 2018;320(8):835–6.

    Article  Google Scholar 

  5. •• Merrill SB, Sohl BS, Thompson RH, Reese AC, Parekh DJ, Lynch JH, Grob BM, Williams DH, Lee RK, Zaslau S, Guzzo TJ. The balance between open and robotic training among graduating Urology residents—does surgical technique need monitoring?. J Urol. 2020;203(5):996–1002. This study was the first objective evaluation of the trends of robotic versus open surgery utilized in residency training, prompting the need for assessment of resident training quality since the institution of robotics.

  6. Richards MK, McAteer JP, Drake FT, Goldin AB, Khandelwal S, Gow KW. A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training. JAMA Surg. 2015;150(2):169–72.

    Article  Google Scholar 

  7. • Okhunov Z, Safiullah S, Patel R, Juncal S, Garland H, Khajeh NR, Martin J, Capretz T, Cottone C, Jordan ML, McDougall E. Evaluation of urology residency training and perceived resident abilities in the United States. J Surg Educ. 2019;76(4):936–48. A nonbiased survey evaluating Urology resident opinions regarding their training and the increased trend towards fellowship pursuit for further training.

  8. Klingensmith ME, Cogbill TH, Luchette F, Biester T, Samonte K, Jones A, Lewis FR, Malangoni MA. Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship. Ann Surg. 2015;262(3):449–55.

    Article  Google Scholar 

  9. Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: are residents ready? J Am Coll Surg. 2013;216(4):764–71.

    Article  Google Scholar 

  10. • Khalafallah YM, Bernaiche T, Ranson S, Liu C, Collins DT, Dort J, et al. Residents’ views on the impact of robotic surgery on general surgery education. J Surg Educ. 2020. https://doi.org/10.1016/j.jsurg.2020.10.003. Although a small sample size, the large portion of residents feeling as though robotic surgery has been detrimental to their education, particularly on open and laparoscopic surgery, further enforces the need for improved training curricula to compensate for advancements in surgical technology.

  11. Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW, Wexner SD, Martinez JM, Ross SB, Awad MM, Franklin ME. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440–9.

    Article  Google Scholar 

  12. Kassite I, Bejan-Angoulvant T, Lardy H, Binet A. A systematic review of the learning curve in robotic surgery: range and heterogeneity. Surg Endosc. 2019;33(2):353–65.

    Article  CAS  Google Scholar 

  13. Lovegrove CE, Elhage O, Khan MS, Novara G, Mottrie A, Dasgupta P, Ahmed K. Training modalities in robot-assisted urologic surgery: a systematic review. Eur Urol Focus. 2017;3(1):102–16.

    Article  Google Scholar 

  14. Soomro NA, Hashimoto DA, Porteous AJ, Ridley CJ, Marsh WJ, Ditto R, Roy S. Systematic review of learning curves in robot-assisted surgery. BJS open. 2020;4(1):27–44.

    Article  CAS  Google Scholar 

  15. Mehaffey JH, Michaels AD, Mullen MG, Yount KW, Meneveau MO, Smith PW, Friel CM, Schirmer BD. Adoption of robotics in a general surgery residency program: at what cost? J Surg Res. 2017;1(213):269–73.

    Article  Google Scholar 

  16. Tsai SH, Tseng PT, Sherer BA, Lai YC, Lin PY, Wu CK, Stoller ML. Open versus robotic partial nephrectomy: systematic review and meta‐analysis of contemporary studies. Int J Med Rob Comput Assisted Surg. 2019;15(1):e1963.

  17. • Rusch P, Ind T, Kimmig R, Maggioni A, Ponce J, Zanagnolo V, Coronado PJ, Verguts J, Lambaudie E, Falconer H, Collins JW. Recommendations for a standardised educational program in robot assisted gynaecological surgery: consensus from the Society of European Robotic Gynaecological Surgery (SERGS). Facts, views & vision in ObGyn. 2019;11(1):29. The structure outlined in this paper proved to be highly effective in training and, in combination with other proposed training etiologies, could prove to be of great benefit for designing a standardized resident robotics curriculum.

  18. • Mariani A, Pellegrini E, Enayati N, Kazanzides P, Vidotto M, De Momi E. Design and evaluation of a performance-based adaptive curriculum for robotic surgical training: a pilot study. In 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) 2018 (pp. 2162–2165). IEEE. The adaptive leading technique proposed allowed for significantly greater improvement and advancement in surgical skills, which may allow this concept to act as a scaffold for creating a standardized robotics curriculum for resident training in the future.

  19. Kobraei EM, Bohnen JD, George BC, Mullen JT, Lillemoe KD, Austen WG, Liao EC. Uniting evidence-based evaluation with the ACGME plastic surgery milestones: a simple and reliable assessment of resident operative performance. Plast Reconstr Surg. 2016;138(2):349e-e357.

    Article  CAS  Google Scholar 

  20. George BC, Teitelbaum EN, Meyerson SL, Schuller MC, DaRosa DA, Petrusa ER, Petito LC, Fryer JP. Reliability, validity, and feasibility of the Zwisch scale for the assessment of intraoperative performance. J Surg Educ. 2014;71(6):e90–6.

    Article  Google Scholar 

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Correspondence to Suzanne B. Merrill.

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Hague, C.M., Merrill, S.B. Integration of Robotics in Urology Residency Programs: an Unchecked Technological Revolution. Curr Urol Rep 22, 47 (2021). https://doi.org/10.1007/s11934-021-01062-w

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