Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Department of Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Mailstop 8109-22-9905, St. Louis, MO, 63110-1093, USA.
Surg Endosc. 2024 Feb;38(2):894-901. doi: 10.1007/s00464-023-10436-9. Epub 2023 Oct 12.
Evidence for how to best train surgical residents for robotic bariatric procedures is lacking. We developed targeted educational resources to promote progression on the robotic bariatric learning curve. This study aimed to characterize the effect of resources on resident participation in robotic bariatric procedures.
Performance metrics from the da Vinci Surgical System were retrospectively reviewed for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases involving general surgery trainees with a single robotic bariatric surgeon. Pictorial case guides and narrated operative videos were developed for these procedures and disseminated to trainees. Percent active control time (%ACT)-amount of trainee console time spent in active instrument manipulations over total active time from both consoles-was the primary outcome measure following dissemination. One-way ANOVA, Student's t-tests, and Pearson correlations were applied.
From September 2020 to July 2021, 50 cases (54% SG, 46% RYGB) involving 14 unique trainees (PGY1-PGY5) were included. From November 2021 to May 2022 following dissemination, 29 cases (34% SG, 66% RYGB) involving 8 unique trainees were included. Mean %ACT significantly increased across most trainee groups following resource distribution: 21% versus 38% for PGY3s (p = 0.087), 32% versus 45% for PGY4s (p = 0.0009), and 38% versus 57% for PGY5s (p = 0.0015) and remained significant when stratified by case type. Progressive trainee %ACT was not associated with total active time for SG cases before or after intervention (pre r = - 0.0019, p = 0.9; post r = - 0.039, p = 0.9). It was moderately positively associated with total active time for RYGB cases before dissemination (r = 0.46, p = 0.027) but lost this association following intervention (r = 0.16, p = 0.5).
Use of targeted educational resources promoted increases in trainee participation in robotic bariatric procedures with more time spent actively operating at the console. As educators continue to develop robotic training curricula, efforts should include high-quality resource development for other sub-specialty procedures. Future work will examine the impact of increased trainee participation on clinical and patient outcomes.
缺乏关于如何最好地培训外科住院医师进行机器人减重手术的证据。我们开发了有针对性的教育资源，以促进机器人减重学习曲线的进展。本研究旨在描述资源对住院医师参与机器人减重手术的影响。
回顾性分析了涉及普外科住院医师和单一机器人减重外科医生的袖状胃切除术（SG）和 Roux-en-Y 胃旁路术（RYGB）病例的达芬奇手术系统的性能指标。为这些手术制作了图片案例指南和旁白手术视频，并分发给住院医师。传播后，主要观察指标是控制台主动控制时间百分比（%ACT）-受训者控制台主动仪器操作时间占两个控制台总主动时间的百分比。应用单因素方差分析、学生 t 检验和 Pearson 相关性分析。
从 2020 年 9 月到 2021 年 7 月，共有 50 例（54%SG，46%RYGB）涉及 14 名独特的受训者（PGY1-PGY5）。在传播后的 2021 年 11 月至 2022 年 5 月期间，共有 8 名独特的受训者参与了 29 例（34%SG，66%RYGB）。在资源分配后，大多数受训者组的平均%ACT 显著增加：PGY3 组从 21%增加到 38%（p=0.087），PGY4 组从 32%增加到 45%（p=0.0009），PGY5 组从 38%增加到 57%（p=0.0015），并且在按病例类型分层时仍然具有统计学意义。在干预前后，SG 病例的渐进式受训者%ACT 与总主动时间无关（干预前 r=-0.0019，p=0.9；干预后 r=-0.039，p=0.9）。在传播前，它与 RYGB 病例的总主动时间呈中度正相关（r=0.46，p=0.027），但在干预后失去了这种相关性（r=0.16，p=0.5）。
使用有针对性的教育资源促进了住院医师参与机器人减重手术的增加，同时在控制台的主动操作时间也有所增加。随着教育工作者继续开发机器人培训课程，应努力为其他亚专业手术开发高质量的资源。未来的工作将研究增加住院医师参与对临床和患者结局的影响。
