title: Robotic surgery: identifying the learning curve through objective measurement of skill.
abstract: BACKGROUND
  The incorporation of new devices into surgical practice often requires that surgeons acquire and master new skills. We studied the learning curve for intracorporeal knot tying in robotic surgery.
  
  
  METHODS
  We developed an objective scoring system to evaluate knot tying and tested eight attending surgeons during 3 weeks of training on a surgical robot. Each performed intracorporeal knot tying tasks both before and after robotic skills training. These performances were compared to their laparoscopic knots and analyzed to determine and define skill improvement.
  
  
  RESULTS
  Baseline laparoscopic knot completion took 140 sec (range, 47-432), with a mean composite score of 77 (100 possible), whereas robotic knot tying took 390 sec, with a mean composite score of 40. After initial robotic training, times decreased by 65% to 139 sec and scores increased to 71. With more training, completion times and composite scores were improved and errors were reduced.
  
  
  CONCLUSIONS
  Like any new technology, surgical robotics requires dedicated training to achieve mastery. Initially, even experienced laparoscopists may register an inferior performance. However, after adequate training, surgeons can exceed their laparoscopic performance, completing intracorporeal knots better and faster using robotics.
authors.affiliation: Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA. lchang@u.washington.edu
authors.forename: L
authors.initials: L
authors.lastname: Chang
authors.forename: R M
authors.initials: RM
authors.lastname: Satava
authors.forename: C A
authors.initials: CA
authors.lastname: Pellegrini
authors.forename: M N
authors.initials: MN
authors.lastname: Sinanan
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007858:Learning; D009048:Motor Skills; D015588:Observer Variation; D012107:Research Design; D012371:Robotics / Q000193:education*; D016037:Single-Blind Method; D013536:Suture Techniques / Q000193:education*; D013664:Teaching Materials; D014743:Videotape Recording