Hays Sarah B, Rojas Aram, Kuchta Kristine, Choi Sung Hoon, Corvino Gaetano, Mehdi Syed Abbas, Talamonti Mark, Hogg Melissa
Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
Department of Surgery, University of Chicago, Chicago, IL, USA.
Surg Endosc. 2025 May;39(5):3298-3306. doi: 10.1007/s00464-025-11712-6. Epub 2025 Apr 14.
Despite growing diversity of surgical approaches, surgical residents must learn the breadth of general surgery in a finite time. Accordingly, there is increasing demand for the development of standardized, proficiency-based training curricula to help teach novice surgeons the necessary technical skills quickly. The aim of this study was to evaluate resident performance and opinion of an open versus robotic approach after completion of a robotic training curriculum.
From 2019 to 2022, PGY-3 general surgery residents completed a two-week dedicated robotic simulation curriculum, which included open and robotic interrupted hepaticojejunostomy (IHJ) and pancreaticojejunostomy (PJ) drills on biotissue models. The drills were recorded and graded according to the modified Objective Structured Assessment of Technical Skills (OSATS) by two independent blinded graders, in addition to time duration. The primary outcomes were OSATS score and drill duration. Mental demand was assessed using the NASA Task Load Index (TLX), Borg Exertion Scale, and Edwards Arousal Rating.
Twenty-three residents participated in the study. For IHJ drills, residents had higher OSATS scores (p = 0.0297) and were faster (p < 0.0001) with an open approach. A similar trend was observed for PJ drills, with higher OSATS scores and shorter time duration with an open approach. However, there was no significant difference in NASA-TLX, Borg Exertion Scale, or Edwards Arousal Rating for robotic IHJ compared to open. The residents endorsed higher NASA-TLX scores for robotic PJ. 100% of the residents viewed open training as extremely important, while 73.9% reported the same for robotic training.
PGY-3 surgical residents have greater comfort and skill with open techniques compared to robotic. This may be due to lack of robotic exposure early in surgical training, as opposed to open technique which is established early in residency. More deliberate integration of robotic training into residency is necessary for residents to catch up to open techniques.
尽管手术方法日益多样化，但外科住院医师必须在有限的时间内掌握普通外科的广泛知识。因此，对开发标准化、基于熟练度的培训课程的需求日益增加，以帮助新手外科医生快速掌握必要的技术技能。本研究的目的是评估在完成机器人培训课程后，住院医师对开放手术与机器人手术方法的操作表现和看法。
2019年至2022年，三年级普通外科住院医师完成了为期两周的专门机器人模拟课程，其中包括在生物组织模型上进行开放和机器人间断肝空肠吻合术（IHJ）以及胰空肠吻合术（PJ）练习。练习过程被记录下来，并由两名独立的盲评人员根据改良的客观结构化技术技能评估（OSATS）进行评分，同时记录练习时长。主要结果是OSATS评分和练习时长。使用美国国家航空航天局任务负荷指数（TLX）、博格用力量表和爱德华兹觉醒评分来评估心理需求。
23名住院医师参与了该研究。对于IHJ练习，住院医师采用开放手术方法时的OSATS评分更高（p = 0.0297）且速度更快（p < 0.0001）。PJ练习也观察到类似趋势，开放手术方法的OSATS评分更高且练习时长更短。然而，与开放手术相比，机器人IHJ在NASA - TLX、博格用力量表或爱德华兹觉醒评分方面没有显著差异。住院医师对机器人PJ的NASA - TLX评分更高。100%的住院医师认为开放手术培训极其重要，而73.9%的住院医师对机器人手术培训也持同样看法。
与机器人手术相比，三年级外科住院医师对开放手术技术更熟练且操作更自如。这可能是由于在外科培训早期缺乏机器人手术的接触，而开放手术技术在住院医师培训早期就已确立。有必要将机器人手术培训更有针对性地融入住院医师培训中，以便住院医师能赶上开放手术技术。
