Utilizing objective performance indicators to assess resident autonomy during robotic cholecystectomy.

Background: The current evaluation of surgical resident operative autonomy consists primarily of self-report and is prone to bias. Objective performance indicators (OPIs) generated from the da Vinci Surgical System capture objective intraoperative data providing an opportunity to evaluate the intraoperative resident experience more accurately. This study investigates the ability of OPIs to describe resident autonomy during robotic cholecystectomy.

Laparoscopic vs robotic inguinal hernia repair: a comparison of learning curves and skill transference in general surgery residents.

Background: There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents' learning curve and skill transference within the two minimally invasive platforms.

Structured Resident Training in Robotic Surgery: Recommendations of the Robotic Surgery Education Working Group.

Objective: A universal resident robotic surgery training pathway that maximizes proficiency and safety has not been defined by a consensus of surgical educators or by surgical societies. The objective of the Robotic Surgery Education Working Group was to develop a universal curriculum pathway and leverage digital tools to support resident education.

Design: The two lead authors (JP and YN) contacted potential members of the Working Group.

Common Components of General Surgery Robotic Educational Programs.

Objective: Robotically assisted surgery has become more common in general surgery, but there is limited guidance from the Accreditation Council for Graduate Medical Education (ACGME) regarding this type of training. We sought to determine common elements and differences in the robotic educational curricula developed by general surgery residency programs.

Design: Robotic educational curricula were obtained from the 7 individuals who presented at the workshop, "Robotic Education in General Surgery" at the 2023 Association of Program Directors in Surgery annual meeting.

What influences general surgery residents' prospective entrustment and operative time in robotic inguinal hernia repairs.

Introduction: Teaching residents robotic-assisted inguinal hernia repair (RIHR) is an increasingly common extension of contemporary surgical training. This study sought to investigate what variables would influence operative time (OT) and resident prospective entrustment in RIHR cases.

Methods: We prospectively collected 68 resident RIHR operative performance evaluations with a validated instrument.

Robotic Enhanced-View Totally Extraperitoneal vs Intraperitoneal Onlay Mesh Evaluation: 1-Year Exploratory Outcomes of the REVEAL Randomized Clinical Trial.

Background: Patients with small- to medium-sized ventral hernias randomized to robotic enhanced-view totally extraperitoneal (eTEP) or robotic intraperitoneal onlay mesh (rIPOM) previously demonstrated comparable 30-day patient-reported outcomes. Here we report 1-year exploratory outcomes for this multi-center, patient-blinded randomized clinical trial.

Study Design: Patients with midline ventral hernias 7 cm wide or less undergoing mesh repair were randomized to robotic eTEP or rIPOM.

Is Robotic Console Time a Surrogate for Resident Operative Autonomy?

Objective: Robotic-assisted surgery is an increasing part of general surgery training, but resident autonomy on the robotic platform can be hard to quantify. Robotic console time (RCT), the percentage of time the resident controls the console, may be an appropriate measure of resident operative autonomy. This study aims to characterize the correlation between objective resident RCT and subjectively scored operative autonomy.

What factors impact surgical operative time when teaching a resident in the operating room.

Purpose: Resident involvement would likely lead to prolonged operative time of a surgical case performed at academic medical centers. However, little is known about factors beneath this phenomenon. The purpose of this study was to investigate whether factors from case (procedure type, surgical case complexity, and surgical approach), teacher (attending surgeon experience and gender), and learner (resident postgraduate training year and gender) would influence operative time of surgical cases involved teaching a resident (SCT).

Cost analysis of training residents in robotic-assisted surgery.

Introduction: Use of robotic-assisted surgery is increasing, and resident involvement may lead to higher costs. We investigated whether senior resident involvement in noncomplex robotic cholecystectomy (RC) and inguinal hernia (RIH) would take more time and cost more when compared to non-robotic cholecystectomy (NRC) and inguinal hernia repair (NRIH).

Methods: We extracted surgery duration and total cost of NRC, NRIH, RC, and RIH from 7/2016 to 6/2020 with senior resident (PGY4-5) involvement.

Distortions in the Balance Between Teaching and Efficiency in the Operating Room.

Introduction: The balance between teaching and operative efficiency (i.e., continuing operative case progression) is difficult for even the most experienced master surgeon educators.

Robotic eTEP versus IPOM evaluation: the REVEAL multicenter randomized clinical trial.

Background: For small to medium-sized ventral hernias, robotic intraperitoneal onlay mesh (rIPOM) and enhanced-view totally extraperitoneal (eTEP) repair have emerged as acceptable approaches that each takes advantage of robotic instrumentation. We hypothesized that avoiding mesh fixation in a robotic eTEP repair offers an advantage in early postoperative pain compared to rIPOM.

Methods: This is a multi-center, randomized clinical trial for patients with midline ventral hernias ≤ 7 cm, who were randomized to rIPOM or robotic eTEP.

The robot doesn't lie: real-life validation of robotic performance metrics.

Background: Degree of resident participation in a case is often used as a surrogate marker for operative autonomy, an essential element of surgical resident training. Previous studies have demonstrated a considerable disagreement between the perceptions of attending surgeons and trainees when it comes to estimating operative participation. The Da Vinci Surgical System dual console interface allows machine generated measurements of trainee's active participation, which has the potential to obviate the need for labor intensive direct observation of surgical procedures.

Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States.

Background: Symptomatic biliary and gallbladder disorders are common in adults with cystic fibrosis (CF) and the prevalence may rise with increasing CF transmembrane conductance regulator modulator use. Cholecystectomy may be considered, but the outcomes of cholecystectomy are not well described among modern patients with CF.

Aim: To determine the risk profile of inpatient cholecystectomy in patients with CF.

Expectations versus reality: trainee participation on the robotic console in academic surgery.

Introduction: Trainees underestimate the amount of operative autonomy they receive, whereas faculty overestimate; this has not been studied in robotics. We aimed to assess the perceptions and expectations of our general surgery trainees and faculty on robotic console participation in academic surgery.

Methods: A survey was administered to general surgery robotic faculty and trainees eligible to sit at the console.

A direct comparison of robotic and laparoscopic hernia repair: patient-reported outcomes and cost analysis.

Purpose: Hernia repair is one of the most commonly performed surgeries in the United States. Since the introduction of the Da Vinci robot, robot-assisted hernia repairs have become more common. In this study we aim to directly compare robotic and laparoscopic hernia repairs as well as explore potential cost differences.

Emergency Presentations of Diverticulitis.

Acute diverticulitis is a common condition that has been increasing in incidence in the United States. It is associated with increasing age, but the pathophysiology of acute diverticulitis is still being elucidated. It is now believed to have a significant contribution from inflammatory processes rather than being a strictly infectious process.

Identifying Priorities for Faculty Development in General Surgery Using the Delphi Consensus Method.

Objective: Faculty teaching skills are critical for effective surgical education, however, which skills are most important to be taught in a faculty development program have not been well defined. The objective of this study was to identify priorities for faculty development as perceived by surgical educators.

Design: We used a modified Delphi methodology to assess faculty perceptions of the value of faculty development activities, best learning modalities, as well as barriers and priorities for faculty development.

Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates.

Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer.

Introduction: Percutaneous endoscopic gastrostomy (PEG) tubes are an effective modality for enteral nutrition in patients with head and neck cancer; however, there have been documented case reports of "seeding" of the abdominal wall by the theoretic risk of dragging the tube along the tumor during PEG placement. The objective of this study is to determine the incidence and contributing risk factors leading to metastasis to the abdominal wall following PEG placement in patients with head and neck cancer.

Methods: A retrospective chart review was performed on patients diagnosed with head and neck malignancy who underwent PEG placement between 1/5/2009 and 12/22/2014.

Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy.

Introduction: Peroral endoscopic myotomy (POEM) is an emerging treatment for esophageal achalasia. Postoperative reflux has been found in a significant number of patients, but it is unknown whether subjective reports of reflux correlate with objective pH testing. The purpose of this study was to compare the objective rate of reflux with standardized reflux symptom scales after POEM.

Endoscopic mucosal resection for staging and treatment of early esophageal carcinoma: a single institution experience.

Background: Endoscopic mucosal resection (EMR) has emerged for evaluation and treatment of esophageal nodules. We report our initial experience with EMR for T staging and management of early esophageal cancer.

Methods: We reviewed patients undergoing EMR for esophageal adenocarcinoma between 2008 and 2013.