Learning Curve of a Robotic Bio-Tissue Intestinal Anastomosis: Implications for Surgical Training Curricula

Objective: The integration of robotic surgical training in a time-scarce residency program is a challenge for surgical educators. Simulation-based training is a tool that allows residents to acquire the necessary robotic skills without compromising patient safety. This study aimed to assess the learning curve of a robotic inanimate intestinal anastomosis drill.

Design: Two trained graders performed a video-based assessment of each attempt of a side-to-side intestinal anastomosis drill using the Objective Structured Assessment of Technical Skill (OSATS) scale. Residents who achieved a passing score of 28 were included in the study. We assessed the number of attempts required to achieve a passing score and evaluated technical performance on different OSATS domains. Data were analyzed using independent t-test, 1-way ANOVA, and binary logistic regression.

Setting: The University of Texas Southwestern PARTICIPANTS: 33 residents across 4 academic years RESULTS: Thirty-three residents performed 139 attempts with a mean of 4.2 ± 2 attempts per resident. On average, 3.3 attempts were required to achieve a passing score. Average OSATS score increased from 21.7 to 27.2 between the 1st and the 4th attempt, respectively (p < 0.001). Of the OSATS subcategories, time and motion showed the greatest score improvement of 1.5 on a 5-point Likert scale, 95% CI [0.82, 2.18] (p < 0.001). Despite varying baseline OSATS scores between residents on initial assessment, there was no significant difference in the final attempt score. On the initial attempt, a lower score and failure to finish were associated with greater odds of requiring 5 or more attempts to pass the drill.

Conclusion: All OSATS metrics improved on an intestinal anastomosis drill after simulation training. A maximum of 6 attempts were required to achieve a passing score. Initial performance strongly predicts the number of attempts required to achieve a passing score. This feasible and effective drill provides trainees with robotic intestinal anastomosis training.