Concurrent robotic colorectal surgical oncology training within a structured mentored international fellowship program

Abstract

Robotic colorectal surgery is increasingly adopted worldwide, with mentored programs for established surgeons becoming more common. However, there is a paucity of dedicated robotic training programs for colorectal fellows. This study aims to assess the feasibility and efficacy of a structured, apprentice-based robotic colorectal training program delivered to multiple fellows concurrently. The fellowship program incorporates simulation training, dry/wet laboratory work, dedicated robotic console time in the operating room (OR) and individualised mentorship. Overall robotic proficiency was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) and procedure-specific proficiency was assessed using a modified European Academy of Robotic Colorectal Surgery (EARCS) Global Assessment Score (GAS) throughout the fellowship. A total of 59 cases (29 right hemicolectomies, 30 anterior resections) were evaluated between August 2023 and July 2024. Significant improvements were observed in GEARS scores (p = 0.0065) and modified GAS for both right hemicolectomies (p = 0.0052) and anterior resections (p = 0.0005), demonstrating a high level of competence and independence. Mean operative times were 213 min (right hemicolectomy) and 328 min (anterior resection). Median length of stay in the hospital was 2 days (right hemicolectomy) and 4 days (anterior resection). Median lymph node yield was 29 (right hemicolectomy) and 26 (anterior resection). There was 0% involved margins for both procedures. Robotic colorectal surgical oncology training delivered to multiple fellows concurrently in an apprenticeship model with dedicated console time is achievable and successful, leading to high levels of robotic competency and independence, whilst maintaining a high standard of clinical care and oncological outcome.

Keywords: Fellowship; Robotic colorectal surgery; Training.

Fig. 1

Global Evaluative Assessment of Robotic Skills (GEARS). Each fellow was asked to self-assess their robotic skills at the beginning and at the end of the fellowship in six domains: depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy and robotic control. Proficiency in each domain was scored on a 5-point Likert Scale, with an overall performance score ranging from 6 to 30. Scores from first month were compared with the scores from the last month. Paired t-test, p = 0.0065

Fig. 2

Modified Global Assessment Score (GAS) for Robotic Right Hemicolectomies. Every two months, each fellow assessed their proficiency in performing a robotic right hemicolectomy. The maximum score is 24 and a score of 20 or above represents independent and competent performance. Scores from the first two-month period were compared with the final two-month period. Paired t-test, p = 0.0052

Fig. 3

Modified Global Assessment Score (GAS) for Robotic anterior resections. Every two months, each fellow assessed their proficiency in performing a robotic anterior resection. The maximum score is 54 and a score of 45 or above represents independent and competent performance. Scores from the first two-month period were compared with the final two-month period. Paired t-test, p = 0.0005