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

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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. Outpatient RIHR cases performed by 11 general surgery residents during 2020–2022 were included. The overall OT of matched cases was extracted from hospital billing; matched procedural step-specific OT was obtained from Intuitive Data Recorder (IDR). Statistical analysis was performed using Pearson correlation and one-way ANOVA.

Results

The evaluation instrument reliably assessed residents’ RIHR performance (Cronbach’s α = 0.93); residents’ prospective entrustment strongly correlated with overall guidance provided by attending surgeon (r = 0.86, p < 0.0001) and operative plan and judgment (r = 0.85, p < 0.0001). The overall OT was significantly associated with resident’s team management (r = − 0.35, p = 0.011). Procedural step-specific OT was significantly associated with residents’ step-specific skill (r = − 0.32, p = 0.014). On average, RIHR cases with the highest level of prospective entrustment (Resident can teach junior) showed the shortest step-specific OT. Entrustment level 3 (Reactive guidance needed) was the turning point of all four RIHR procedural step-specific OT.

Conclusions

Our findings suggest that in RIHR, attending guidance, resident operative plan and judgment, and resident technical skill contribute to resident prospective entrustment; resident team management, technical skill, and attending guidance influence operative time, which in turn impacts attendings’ determination of resident prospective entrustment. Future studies with a larger sample size are needed to further validate the findings.

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Funding

This project was supported by the Intuitive Education Research Grant.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University, 395 W 12th Ave, Columbus, OH, 43210, USA

    Michael Meara, Heidi Pieper, Ingrid Woelfel, Theresa Wang, David Renton & Xiaodong Chen

  2. Research Division, Intuitive Surgical Inc, Norcross, GA, 30092, USA

    Mallory Shields

Authors
  1. Michael Meara
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  2. Heidi Pieper
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  3. Mallory Shields
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  4. Ingrid Woelfel
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  5. Theresa Wang
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  6. David Renton
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  7. Xiaodong Chen
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Corresponding author

Correspondence to Xiaodong Chen.

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Disclosures

Dr. Chen receives grants from AMA, OSU College of Medicine, and Intuitive Foundation and is on the Editorial Board of Global Surgical Education—Journal of the Association for Surgical Education. Dr. Meara receives a grant and honoraria from Intuitive Foundation. Dr. Shields is an employee of Intuitive Surgical Inc. Drs. Renton, Woelfel, Wang and Ms. Pieper have no conflicts of interest or financial ties to disclose.

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Meeting presentation

Results presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) conference, Montréal, QC Canada.

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Meara, M., Pieper, H., Shields, M. et al. What influences general surgery residents’ prospective entrustment and operative time in robotic inguinal hernia repairs. Surg Endosc 37, 7908–7913 (2023). https://doi.org/10.1007/s00464-023-10242-3

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  • DOI: https://doi.org/10.1007/s00464-023-10242-3

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