Residents' Views on the Impact of Robotic Surgery on General Surgery Education

摘要

OBJECTIVE: The use of the da Vinci Robot has been fast growing in general surgery in the United States over the past decade. While the financial cost of robot-assisted procedures has been studied, there has been limited research on the educational cost of the robotic approach on general surgery trainees, and their surgical skills. DESIGN: Analysis of anonymous educational survey responses collected from residents, in addition to case logs which were used as a retrospective review for the 5 years preceding the survey. SETTING: One thousand bed, tertiary care hospital general surgery residency program. PARTICIPANTS: Twenty-four enrolled general surgery residents in 2018. RESULTS: There has been a rapid expansion in the use of robotics in general surgery. In 2017 the total number of general surgery cases using the da Vinci robot increased 6 fold over that in 2013 (23 cases in 2013, 136 in 2017), while both open and laparoscopic procedures have witnessed about a 33 drop in the case volume during those years. Almost all residents would prefer a residency program which offers the da Vinci robot for care and training (95), however, 38 of general surgery residents reported that the presence of robotic-assisted surgery had a "detrimental" effect on their surgical training. Senior residents were more likely to report a "detrimental" effect (56 vs 27). A third of the residents believe that robotic surgery is impeding their ability to learn open and laparoscopic surgical techniques, and only 25 denied a negative impact. Senior residents are more likely to report this negative impact (67 vs 13). CONCLUSIONS: Reforms in residency curricula need to be in place to accommodate the expansion of the use of the robotic platform in general surgery. A subjective survey of the residents suggests that robotic surgery can potentially impede the development of residents' open and laparoscopic surgical skills. ((C) 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)