Robotic surgical education: a systematic review of strategies trainees and attendings can utilize to optimize skill development

Abstract

Background: Robotic surgery has rapidly expanded across specialties, creating a challenge for educators to teach future surgeons an additional modality. Given this, we sought to review robotic training, focusing on trainee curriculums, simulation, and skill assessment. Methods: A comprehensive search of PubMed and Embase was conducted from 2015 to August 2024 for studies reporting approaches to teach surgical trainees robotic surgery in the pelvis, abdomen and thorax, and how to assess performance. Studies outside these areas, that focused on other modalities or that focused on other team members were excluded. Data was compiled into a structured form and appropriate assessment tools were used to evaluate risk of bias. Descriptive statistics described specialty, curriculum components, simulation types, simulation focus, wet lab material, and types of assessment frequencies. Results: A total of 188 articles were included in the review. The majority of articles discussed types of simulation: 59 virtual reality simulation, 50 dry labs, 30 on wet labs, and 9 events. Skill assessment was discussed in 81 of the articles and curriculums were covered in 33 articles. Robotic curriculums were found to have a combination of didactics, simulation, bed side assistance, and active time on the console in the operating room. Additional adjuncts include operative guides, a focus on procedural steps, simulator gamification, and coaching. Evaluating robotic performance was found to have diverging approaches with some researchers focusing on video review and manual assessments while others are working to develop automated assessments through data recorded by robotic systems. Overall, many studies were low quality with a high risk of bias, especially observational studies which were the most common. Conclusions: While there is consensus regarding robotic curricular components and the importance of simulation there are still areas of ongoing research. For simulation, the way to incorporate wet and dry labs as well as the utility of virtual simulation after proficiency is still uncertain. For skill assessment, there continue to be tensions between automated scores or active control time and video review from experts, peers, or crowdsourced. These uncertainties should be addressed with larger multicenter studies given the overall low quality of existing research.