title: Transfer of training in robotic-assisted microvascular surgery.
abstract: BACKGROUND
  Transfer of training refers to the ability to transfer acquired skills from one discipline to another. This study aims to determine whether experience in traditional freehand microsurgery facilitates mastery of robotic microsurgery.
  
  
  METHODS
  Microsurgical anastomoses of coronary arteries harvested from explanted pig models were used to demonstrate whether prior experience with microsurgery is required in learning robot-assisted microsuturing. Eighty microsurgical anastomoses were performed. Three fully trained vascular surgeons (n = 3) (Group A) and 5 midlevel surgical residents (n = 5) (Group B) performed the anastomoses. Each subject performed 5 freehand and 5 robotic-assisted (Zeus robotic system) anastomoses. Anastomosis time and integrity of anastomoses were recorded, including errors of management (EOM) (breaking suture, breaking knots, breaking or damaging needles).
  
  
  RESULTS
  For fully trained surgeons, all anastomoses in the robotic-assisted group were mechanically intact. There was significantly increased anastomosis time with the robot (Robot: 14 minutes, versus freehand: 7.2 minutes, P < 0.01). The robotic-assisted anastomoses were associated with a higher EOM (Robot: 1.2, versus freehand: 0.3, P < 0.01). Surgical trainees had longer anastomosis times with robotic assistance (Robot: 14.8 minutes, versus freehand, 12.7 minutes; P < 0.01) and increased EOM (Robot: 1.6, versus freehand: 1.0; P < 0.05).Overall, surgical trainees and fully trained vascular surgeons had longer anastomotic times with robotic assistance [Robot: 14.0 versus 14.8 minutes; P = not significant (NS)], and EOM (Robot: 1.6, versus freehand: 1.2; P = NS) were not significantly different.
  
  
  CONCLUSIONS
  The technical feasibility of performing a safe and efficient robotic-assisted microsurgical anastomosis in explanted vessels was repeatedly tested and demonstrated in this study within reasonable time required for the anastomosis. Compared with conventional microanastomosis, both fully trained surgeons and residents demonstrated an ability to master the robotically assisted procedure with similarly longer anastomosis times and EOM. This study indicates that robotically assisted microanastomosis can be mastered equally well by surgical trainees and fully trained vascular surgeons.
authors.affiliation: University of California, Irvine Aesthetic & Plastic Surgery Institute, State University of New York, Buffalo, NY, USA.
authors.forename: Raffy L
authors.initials: RL
authors.lastname: Karamanoukian
authors.forename: Trung
authors.initials: T
authors.lastname: Bui
authors.forename: Michael P
authors.initials: MP
authors.lastname: McConnell
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
authors.forename: Hratch L
authors.initials: HL
authors.lastname: Karamanoukian
mesh_terms: D000714:Anastomosis, Surgical; D002983:Clinical Competence; D013502:General Surgery / Q000193:education; D007396:Internship and Residency; D008866:Microsurgery / Q000193:education* / Q000379:methods / Q000523:psychology; D012371:Robotics / Q000193:education*; D014163:Transfer, Psychology