Structured Training in Robotic Abdominal Wall Surgery: A Systematic Review of Educational Models, Methodologies, Existing Gaps and Unmet Needs

Abstract

Background: Robotic-assisted abdominal wall surgery demands advanced technical proficiency. The advent of robotic platforms has driven the development of various training approaches, including simulation-based modules, animal models, and structured curricula. This systematic review critically assesses current training strategies and models, comparing their effectiveness in skill acquisition through validated assessment tools and evaluating their implementation from a cost-effectiveness perspective. Methods: A comprehensive search of the scientific literature was conducted across three major databases (PubMed, Embase, Cochrane, Google Scholar) up to April 2025. The study was registered in PROSPERO (CRD420251027155) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected based on inclusion of robotic training programs related to abdominal wall surgery. Results: Out of 3,038 records identified, 8 studies were included. The overall methodological quality was acceptable, with all studies showing moderate risk of bias. Training models varied and included virtual reality simulation (n = 4), inanimate models (n = 3), porcine models (n = 2), and intraoperative training (n = 4). Three studies described integrated, proficiency-based curricula. Skill acquisition was reported using validated tools such as GEARS, OSATS, or the Zwisch scale in only two studies. Reported costs ranged from €40 for silicone models to €600 for porcine models; one study demonstrated $1,207 in cost savings per case post-training. Conclusion: Current training models for robotic-assisted abdominal wall surgery are heterogeneous in design, assessment methods, and cost. While integrated curricula show promise, few studies employ validated tools to evaluate skill acquisition. Further high-quality research is needed to standardize training approaches and assess their cost-effectiveness.