General surgery residents have better technical skills and less stress performing complex drills in open fashion over robotic approach.

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.