title: Intraoperative resident education for robotic laparoscopic gastric banding surgery: a pilot study on the safety of stepwise education.
abstract: BACKGROUND
  Incorporation of robotic surgery into resident education poses questions regarding intraoperative teaching and patient care. This study aimed to evaluate the impact of gradually increasing resident console responsibility on resident competency and patient safety, in the presence of a proctor and bedside surgeon, for robotic laparoscopic-assisted gastric banding (R-LAGB) compared with the classical training model (CTM) of residents as first assistant.
  
  
  METHODS
  Eight clinical year 4 (CY4) residents completed 60 R-LAGB using a one-to-one proctored training model (PTM). R-LAGB was distilled into 7 key steps: gastroesophageal-junction dissection, gastrohepatic ligament dissection, retrogastric space creation, band placement, band closure, gastrogastric suturing, and port placement. Residents performed more complex steps after each case to gain competency in all aspects of the operation. Patient demographics, comorbidities, operative complications, operating times, and clinical outcomes were compared with a control group of 287 R-LAGB cases completed using the CTM (n = 15 CY4 residents).
  
  
  RESULTS
  All residents using the PTM were able to successfully complete an R-LAGB as primary surgeon after a median of 8 operations (range 5 to 11); no residents in the CTM completed an R-LAGB as primary surgeon. Mean operative time was statistically greater in the PTM group (99.3 ± 22.1 minutes) vs CTM (91.5 ± 21.1 minutes) (p = 0.001). There were no intraoperative complications in either group; incidence of postoperative complications was similar between groups.
  
  
  CONCLUSIONS
  All residents in the proctored setting claimed competence and have persistent console experience without significantly increasing procedure complications. PTM, otherwise known as stepwise education, is a safe, standardized method to train surgical residents in R-LAGB.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hashimoto
authors.forename: Ernest D
authors.initials: ED
authors.lastname: Gomez
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.forename: Paula K
authors.initials: PK
authors.lastname: Edelson
authors.forename: Jon B
authors.initials: JB
authors.lastname: Morris
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement; D015391:Gastroplasty / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007432:Intraoperative Period; D010535:Laparoscopy / Q000193:education*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010865:Pilot Projects; D012371:Robotics / Q000193:education*