Robotic surgical skills: acquisition, maintenance, and degradation

Abstract

Background and objectives: The degradation in robotic skills that occurs during periods of robotic surgical inactivity in newly trained surgeons was measured. The role of animate training in robotic skill was also assessed.

Methods: Robotically naive resident and attending surgeons underwent training with the da Vinci robot on needle passage (DN), rocking ring transfer peg board (RPB), and running suture pod tasks (SP). Errors were established to convert actual time to adjusted time. Participants were deemed "proficient" once their adjusted times were within 80% of those set by experienced surgeons through repeated trials. Participants did not use the robot except for repeating the tasks once at 4, 8, and 12 weeks (tests). Participants then underwent animate training and completed a final test within 7 days.

Results: Twenty-five attending and 29 resident surgeons enrolled; 3 withdrew. There were significant increases in time to complete each of the tasks, and in errors, by 4 weeks (Adjusted times: DN: 122.9 +/- 2.2 to 204.2 +/- 11.7, t = 6.9, P < .001; RPB: 262.4 +/- 2.5 to 364.7 +/- 8.0, t = 12.4, P < .001; SP: 91.4 +/- 1.4 to 169.9 +/- 6.8, t = 11.3, P < .001). Times decreased following animate training, but not to levels observed after proficiency training for the RPB and SP modules.

Conclusions: Robotic surgical skills degrade significantly within 4 weeks of inactivity in newly trained surgeons. Animate training may provide different skills than those acquired in the dry lab.

Figure 1.

Modules of the proficiency test.

Figure 2.

Number of trials required to achieve proficiency on RPB and SP.

Figure 3.

Actual time, penalty time for errors (each error = 5 seconds), and adjusted time over the 12 weeks of the study for resident and attending physicians completing the DN module (n=51). Actual times and penalty time for errors were significantly different over the 12 weeks of the study (Actual time, F=15.765, P<.001; Errors, F=17.072, P<.001;Adjusted time, F=18.358, P<.001). Mean ± SEM.

Figure 4.

Actual time, penalty time for errors (each error = 5 seconds), and adjusted time over the 12 weeks of the study for resident and attending physicians completing the RPB module (n=51). Actual times and penalty time for errors were significantly different over the 12 weeks of the study (Actual time, F=43.528, P<.001; Errors, F=63.366, P<.001; Adjusted time, F=74.891, P<.001). Mean ± SEM.

Figure 5.

Actual time, penalty time for errors (each error = 5 seconds), and adjusted time over the 12 weeks of the study for resident and attending physicians completing the SP module (n=46). Actual times and penalty time for errors were significantly different over the 12 weeks of the study (Actual time, F=55.502, P<.001; Errors, F=8.840, P<.001; Adjusted time, F=51.556, P<.001). Mean ± SEM.