Defining digital surgery: a SAGES white paper.

Background: Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas.

Methods: This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology.

Results: In its simplest form, digital surgery inserts a computer interface between surgeon and patient.

Expertise in perception during robotic surgery (ExPeRtS): What we see and what we say.

Background: Given the challenges of teaching in robotic operating rooms, we sought to investigate the language of perceptual expertise used by robotic surgeons, in an effort to improve current approaches to robotic training.

Methods: Expert robotic surgeons reviewed 8 anonymous video clips portraying key portions of two robotic general surgery procedures and their comments were recorded and transcribed. Using content analysis, each transcript was double-coded and reconciled using a consensus developed codebook.

Enhancing robotic efficiency through the eyes of robotic surgeons: sub-analysis of the expertise in perception during robotic surgery (ExPeRtS) study.

Background: Robotic technology affords surgeons many novel and useful features, but two stereotypes continue to prevail: robotic surgery is expensive and inefficient. To identify educational opportunities and improve operative efficiency, we analyzed expert commentary on videos of robotic surgery.

Methods: Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed eight anonymous video clips portraying key portions of two robotic general surgery procedures.

Transforming Surgical Education through a Resident Robotic Curriculum.

Objective: Here, we describe a systematic approach to design, implement, and assess a robotic surgery curriculum for surgical residents. By describing our process, including identifying and addressing institutional challenges, we illustrate successful development of a robust curriculum.

Summary Background Data: As robotic-assisted surgeries increase, educational challenges have emerged and illustrate an alarming impact on medical training.

Teaching in the robotic environment: Use of alternative approaches to guide operative instruction.

Background: With the rapid growth of robotic-assisted surgery, surgical educators recognize the need to develop appropriate curriculum for trainees. However, the unique robotic learning environment challenges educators to determine the most appropriate ways to instruct surgical residents. The purpose of this study was to characterize the instructional techniques used in the robotic teaching environment by observing attending surgeon's language and behaviors during resident robotic dissection.

Integrating Robotic Technology Into Resident Training: Challenges and Recommendations From the Front Lines.

Purpose: To develop recommendations for improving the integration of robotic technology into today's apprentice-based resident training.

Method: During a national meeting in 2017, 24 robotic surgeons were interviewed about their experiences integrating robotic technology into resident training. Qualitative thematic analysis of interview notes and recordings revealed themes related to challenges and recommendations.

A robotic teaching session: separating tool from technique to emphasize a cognitive focused teaching environment.

Most robotic curriculum requires simulation on a console prior to operative exposure. This practice does not permit experiencing the physical collisions with the robotic tools, which occurs during surgery. We designed and evaluated an innovative curriculum to address cognitive components and trouble-shoot robotic collisions when the surgeon lacks haptic feedback.

Microanalysis of video from a robotic surgical procedure: implications for observational learning in the robotic environment.

Without haptic feedback, robotic surgeons rely on visual processing to interpret the operative field. To provide guidance for teaching in this environment, we analyzed intracorporeal actions and behaviors of a robotic surgeon. Six hours of video were captured by the intracorporeal camera during a robot-assisted lower anterior resection.

Using Technological Advances to Improve Surgery Curriculum: Experience With a Mobile Application.

Objective: Our previous home-video basic surgical skills curriculum required substantial faculty time and resources, and was limited by delayed feedback and technical difficulties. Consequently, we integrated that curriculum with a mobile application platform. Our purpose is to describe this application and learner satisfaction.

Current robotic curricula for surgery residents: A need for additional cognitive and psychomotor focus.

Background: Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components.

Methods: We identified 12 residency programs with robotic curricula.

Technical skill improvement with surgical preparatory courses: What advantages are reflected in residency?

Introduction: Sustainability of skill acquisition gained from graduating medical student (GMS) preparatory courses remains uncertain. GMS skills were assessed before (T1) and after a preparatory course (T2) and then again 2 (T3) and 4 (T4) months into residency and compared to surgical interns without such a course.

Methods: In April, GMS took the preparatory course.

Evaluation of a Surgery-Based Adjunct Course for Senior Medical Students Entering Surgical Residencies.

Background: Preparatory courses for senior medical students aim to ease the transition from medical school to residency. We designed a novel adjunct curriculum to enhance students' readiness for surgical internship. This study addresses the feasibility and outcomes of this course.

Descending necrotizing mediastinitis: a modified algorithmic approach to define a new standard of care.

Background: Descending necrotizing mediastinitis (DNM) is a highly morbid infectious process. This uncommon disease process has carried historically a substantial burden of morbidity and mortality. In this study we hypothesized that application of a prospective modified management algorithm would decrease the morbidity and mortality from this highly destructive process.

Complex trait analysis of ventricular septal defects caused by Nkx2-5 mutation.

Background: The occurrence of a congenital heart defect has long been thought to have a multifactorial basis, but the evidence is indirect. Complex trait analysis could provide a more nuanced understanding of congenital heart disease.

Methods And Results: We assessed the role of genetic and environmental factors on the incidence of ventricular septal defects (VSDs) caused by a heterozygous Nkx2-5 knockout mutation.

The significant impact of a competency-based preparatory course for senior medical students entering surgical residency.

Purpose: Previous data suggest that formal, structured preparation might improve knowledge and skills of senior medical students (SMSs) as they transition to surgical residency. However, subsequent impact on clinical performance has not been demonstrated.

Method: The authors developed a comprehensive course for SMSs entering surgical residencies and studied the impact of the course on the subsequent performance of 2010 graduates (n = 22) compared with matched peers (16 nonparticipant controls at authors' home institution and 24 nonparticipant peer controls at outside institutions; total n = 62).

Heterogeneity of genetic modifiers ensures normal cardiac development.

Background: Mutations of the transcription factor Nkx2-5 cause pleiotropic heart defects with incomplete penetrance. This variability suggests that additional factors can affect or prevent the mutant phenotype. We assess here the role of genetic modifiers and their interactions.