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Background: The adoption of new surgical technologies is inevitably accompanied by a learning curve. With the increasing adoption of robotic techniques in benign foregut surgery, it is imperative to define optimal learning pathways, to ensure a clinically safe introduction of such a technique. The aim of this study was to assess the learning curve for robotic hiatal hernia repair with a pre-defined adoption process and proctoring., Methods: The learning curve was assessed in four surgeons in a high-volume tertiary referral centre, performing over a 100 hiatal hernia repairs annually. The robotic adoption process included simulation-based training and a multi-day wet lab-based course, followed by robotic operations proctored by robotic upper GI experts. CUSUM analysis was performed to assess changes in operating time in sequential cases., Results: Each surgeon (A, B, C and D) performed between 22 and 32 cases, including a total of 109 patients. Overall, 40 cases were identified as 'complex' (36.7%), including 16 revisional cases (16/109, 14.7%). With CUSUM analysis inflection points for operating time were seen after 7 (surgeon B) to 15 cases (surgeon B)., Conclusion: The learning curve for robotic laparoscopic fundoplication may be as little as 7-15 cases in the setting of a clearly organized learning pathway with proctoring. By integrating these organized learning pathways learning curves may be shortened, ensuring patient safety, preventing detrimental outcomes due to longer learning curves, and accelerating adoption and integration of novel surgical techniques., (© 2023. The Author(s).)

The COVID-19 pandemic has caused a shift from on-campus to remote online examinations, which are usually difficult to invigilate. Meanwhile, closed-ended question formats, such as true-false (TF), are particularly suited to these examination conditions, as they allow automatic marking by computer software. While previous studies have reported the score characteristics in TF questions in conventional supervised examinations, this study investigates the efficacy of using TF questions in online, unsupervised examinations at the undergraduate level of Biomedical Engineering. We examine the TF and other question-type scores of 57 students across three examinations held in 2020 under online, unsupervised conditions. Our analysis shows significantly larger coefficient of variance (CV) in scores in TF questions (42.7%) than other question types (22.3%). The high CV in TF questions may be explained by different answering strategies among students, with 13.3 ± 17.2% of TF questions left unanswered (zero marks) and 16.4 ± 11.5% of TF questions guessed incorrectly (negative marks awarded). In unsupervised, open-book examination where sharing of answers among students is a potential risk; questions that induce a larger variation in responses may be desirable to differentiate among students. We also observed a significant relationship (r = 0.64, p < 0.05) between TF scores and the overall subject scores, indicating that TF questions are an effective predictor of overall student performance. Our results from this initial analysis suggests that TF questions are useful for assessing biomedical-theme content in online, unsupervised examinations, and are encouraging for their ongoing use in future assessments., (© 2021. Australasian College of Physical Scientists and Engineers in Medicine.)

Remote teaching and assessment are essential for current education. During online examination, online proctoring is often used as a surveillance tool. Little is known about student perceptions on online proctoring. Using an online questionnaire, we found that medical students worry most about unjustified invalidation of their exam due to unstable internet connection, background noise or webcam issues, and privacy issues. It is important to be aware of these worries as they may influence test results., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2021.)

Background: Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown to be associated with a relative long learning curve which might hamper widespread adoption. Therefore, a national structured training pathway for TaTME has been set up in the Netherlands to allow safe implementation. The aim of this study was to monitor safety and efficacy of the training program with 12 centers., Methods: Short-term outcomes of the first ten TaTME procedures were evaluated in 12 participating centers in the Netherlands within the national structured training pathway. Consecutive patients operated during and after the proctoring program for rectal carcinoma with curative intent were included. Primary outcome was the incidence of intraoperative complications, secondary outcomes included postoperative complications and pathological outcomes., Results: In October 2018, 12 hospitals completed the training program and from each center the first 10 patients were included for evaluation. Intraoperative complications occurred in 4.9% of the cases. The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5.0% of patients. Overall postoperative complication rate was 45.0%, with 19.2% Clavien-Dindo ≥ III and an anastomotic leak rate of 17.3%., Conclusions: This study shows that the nationwide structured training program for TaTME delivers safe implementation of TaTME in terms of intraoperative and pathology outcomes within the first ten consecutive cases in each center. However, postoperative morbidity is substantial even within a structured training pathway and surgeons should be aware of the learning curve of this new technique.

We sought to determine if the learning curve in pediatric robotic-assisted laparoscopic pyeloplasty (RALP) for an experienced open surgeon (OS) converting to robotics would be affected by proctoring from an experienced robotic surgeon (RS), and/or the experience of training within the framework of an established robotics program. We reviewed pediatric RALP cases by three surgeons at our institution, including the OS, RS, and a new fellowship-trained surgeon (FTS). We compared the first eight independent RALPs for the OS with the most recent ten RALPs for the RS. As an ancillary analysis, to isolate the impact of proctoring and of a robotics program, we reviewed the first ten cases of the FTS as well the first and last eight cases of the RS at a prior institution. A total of 44 patient charts were reviewed, with a mean follow-up time of 16 months (range 6.7-45 months). Radiologic improvement was seen in all patients with the exception of one who required reoperative pyeloplasty. The FTS, RS, and OS had similar mean operative times; however; when comparing robotic cases at the beginning of each of their learning curves, shorter operative times were achieved by the proctored surgeon (OS). Finally, comparing two RALP cohorts by the RS at his prior institution revealed longer operative times with an inexperienced robotics team. We demonstrate that an experienced open surgeon and fellowship-trained surgeon can quickly attain levels of expertise with pediatric RALP within an established robotic surgical program.

Experienced surgeons commonly mentor trainees as they move through their initial learning curves. During robot-assisted minimally invasive surgery, several tools exist to facilitate proctored cases, such as two-dimensional telestration and a dual surgeon console. The purpose of this study was to evaluate the utility and efficiency of three, novel proctoring tools for robot-assisted minimally invasive surgery, and to compare them to existing proctoring tools. Twenty-six proctor-trainee pairs completed validated, dry-lab training exercises using standard two-dimensional telestration and three, new three-dimensional proctoring tools called ghost tools. During each exercise, proctors mentored trainees by correcting trainee technical errors. Proctors and trainees completed post-study questionnaires to compare the effectiveness of the proctoring tools. Proctors and trainees consistently rated the ghost tools as effective proctoring tools. Both proctors and trainees preferred 3DInstruments and 3DHands over standard two-dimensional telestration (proctors p < 0.001 and p = 0.03, respectively, and trainees p < 0.001 and p = 0.002, respectively). In addition, proctors preferred three-dimensional vision of the operative field (used with ghost tools) over two-dimensional vision (p < 0.001). Total mentoring time and number of instructions provided by the proctor were comparable between all proctoring tools (p > 0.05). In summary, ghost tools and three-dimensional vision were preferred over standard two-dimensional telestration and two-dimensional vision, respectively, by both proctors and trainees. Proctoring tools-such as ghost tools-have the potential to improve surgeon training by enabling new interactions between a proctor and trainee.

The purpose of this study was to assess the feasibility of using live teleconferencing for teaching of new robotic-assisted surgical techniques. This was a prospective study with review of outcomes (Canadian Task Force classification II-3) in a community hospital. In 2009, our community hospital acquired the da Vinci Connect™ System, a technology which allows for live surgeon-to-surgeon interaction during robotic surgery via a secure internet connection. We utilized this technology from March 2009 through March 2011 to perform 28 live robotic surgeries that were observed by surgeons and hospital staff in 14 different US states as well as in France. We also had 14 episodes where new robotic surgeons in our facilities were mentored by experienced robotic surgeons in other geographic locations live through the da Vinci Connect internet connection. We performed two live surgeries for continuing medical education courses with live interactions between the course attendees and the console surgeon. Finally, one surgeon in our hospital proctored new surgeons remotely in distant sites on challenging cases. Utilizing computers that allow an experienced mentor surgeon to interact with less experienced surgeons on a live case is invaluable and presages the way we will train surgeons in the future. This feasibility study validates the need to pursue this technology for future education and training as well as for real-time collaboration.