EP288 - Training Models and Surgical Complexity: Key Determinants of Resident Engagement in Robotic Colorectal Surgery

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Purpose/Background: Robotic-assisted surgery has become integral to colorectal procedures, with the da Vinci Xi system widely adopted. However, training and experience among surgical residents in using robotic technology can vary significantly due to multiple factors. Understanding these variables is crucial for optimizing training and ensuring effective patient care. The complexity of surgery influences residents’ autonomy and time on the da Vinci Xi robotic console. Previous studies suggest that biologic sex may influence surgical performance, though its specific impact on robotic training is not well explored. Additionally, the duration of training and rotation structure, such as preliminary years or research years, may affect readiness to engage with robotic systems.

Our study investigates how factors like residents' biologic sex, length of training, inclusion of dedicated research years, and training structure—comparing traditional rotational models to 1-on-1 apprenticeship models—affect autonomy and time spent on the robotic platform during colorectal surgeries.

Methods/Interventions: After obtaining institutional IRB approval, we reviewed colorectal cases performed on the da Vinci Xi robot from April 2022 to May 2024. Charts were examined to identify demographics and biologic sex of the surgical residents involved. Data on total instruments' active time and residents’ active time were collected using the My Intuitive app and data from Intuitive Surgical. We developed an Adjusted Educational Year (AEY) variable, which excludes non-clinical research years, to more accurately assess residents’ clinical experience compared to traditional PGY designations. Analysis of Variance (ANOVA) was used to compare resident operative time across training models and levels of case complexity, with post hoc Tukey HSD tests identifying mean differences between specific procedures.

Results/Outcomes: A total of 317 colorectal procedures were performed using the da Vinci Xi robot, with 56% for malignant pathologies and 44% for benign conditions. Thirty-three residents participated, comprising 15 females and 18 males. Overall, residents spent an average of 31% active time on the console. Female residents contributed to 42.5% of cases, while male residents accounted for 57.5%, with no significant difference in active time based on biologic sex. Eighty-four percent of cases were conducted by residents at AEY levels 4 through 6. Notably, active time was significantly higher in the apprenticeship model (37%) than in the rotational model (24%), with a p-value of < 0.001(see Table 1). The type of surgery also significantly influenced console active time (p < 0.001; see Table 2).

Conclusion/Discussion: This study identifies key factors influencing residents' autonomy and active time on the da Vinci Xi robotic platform in colorectal surgery. Both female and male residents had similar active console times. The apprenticeship model was associated with increased active time compared to the traditional rotational model, and surgical complexity significantly affected residents' engagement with the robotic system. These findings suggest that optimizing training structures, particularly through apprenticeship models and adjusting for surgical complexity, may enhance resident proficiency and confidence in robotic-assisted surgeries.