Robotic enterorrhaphy model for junior residents: A step closer to the fundamentals of robotic surgery manual skills assessment.

چکیده اصلی

Robotic surgery is increasingly integrated into general surgical practice, creating a need for standardized training methods that objectively assess technical skill acquisition. Current robotic simulation curricula often rely on psychomotor tasks that may not reflect clinically relevant reconstructive procedures. Enterotomy repair requires precise tissue handling and suturing and may serve as a practical benchmark for robotic training. This study evaluated whether a standardized robotic enterotomy repair task could demonstrate reproducible skill acquisition among junior residents. A prospective longitudinal study was conducted involving PGY-1 and PGY-2 general surgery residents performing a standardized two-layer robotic enterotomy repair on a porcine small bowel model using the da Vinci Xi platform. Participants completed three sessions spaced 1-2 weeks apart. The primary outcome was time to task completion. Secondary outcomes included leak testing, technical errors, and exploratory comparisons by postgraduate year and prior robotic training. Changes in performance across sessions were analyzed using a linear mixed-effects model accounting for repeated measures. Thirty-eight residents participated, with 30 completing all three sessions. Mean completion time decreased from 18.47 ± 4.87 min in session 1 to 14.90 ± 6.00 min in session 2 and 13.20 ± 5.60 min in session 3 (p < 0.001). Leak rates declined from 26.3% in session 1 to 20.0% in session 3. Logistic regression analysis accounting for repeated observations demonstrated no significant association between completion time and leak occurrence (OR 1.0003, 95% CI 0.9988-1.0019; p = 0.671). PGY-1 residents demonstrated greater improvement, with convergence between PGY levels by the final session. Residents with prior robotic training demonstrated numerically faster repair times, though differences were not statistically significant. A short, standardized robotic suturing curriculum using a procedure-based enterotomy repair task produces reproducible improvements in technical efficiency among junior surgical residents without compromising repair integrity. This model provides an objective and practical framework for assessing robotic skill acquisition early in surgical training.

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