Towards standardized robotic surgery in gastrointestinal oncology

Purpose: Minimally invasive techniques have revolutionized the field of surgery over the past several decades. Specifically, robotic surgery is increasingly being used for complex operations, although the appreciable learning curve required to become proficient has deterred many surgeons. We describe how use of a proficiency-based training program can decrease the learning curve and lead to standardized robotic surgery. Methods: The steps of a proficiency-based robotic training program are described, including (1) a proficiency-based virtual reality simulation curriculum, (2) an inanimate biotissue curriculum, (3) a video library training, (4) intraoperative evaluation, and (5) skill maintenance with ongoing assessment. The learning curve for robotic gastrointestinal surgery is explored, as well as outcomes compared to laparoscopic and open techniques. Results: The implementation of a proficiency-based robotic training program is feasible. Surgical oncology fellows who participated in the program demonstrated improvement in both the simulation and biotissue curricula. Analyzed as a group, the participants improved in time and errors after the biotissue curriculum. Conclusions: Published outcomes from robotic gastrointestinal surgery have demonstrated safety, feasibility, and preserved oncologic resections. A proficiency-based robotic curriculum is ideal to enable surgeons to achieve mastery in robotic surgery while minimizing the learning curve required.