A structured assessment for robotic microsurgical training
Epublication WebSurg.com, Jun 2014;14(06). URL: http://websurg.com/doi/lt03enalrasheed001
Robotic surgery as a field has expanded rapidly over the past two decades and is being used widely among surgical subspecialties. Its applications in plastic surgery have emerged gradually over the last few years. One of those promising applications is robotic assisted microvascular anastomosis. The purpose of this study was to develop a validated assessment instrument, and then assess the learning curve for robotic assisted microvascular anastomoses. The authors hypothesized that the subjects would demonstrate measurable improvement across multiple domains of performance as a result of robotic practice. Methods: In part 1, an assessment instrument called SARMS (structured assessment of robotic microsurgical skills), which combines the previously validated SAMS (Structured Assessment of Microsurgical Skills) with validated skill domains in robotic surgery was tested. Four blinded expert evaluators graded 6 recorded videos and inter-rater reliability was determined. In part 2, a cohort of 5 microsurgery fellows and 5 Faculty members: each participant performed five robotic assisted micro-anastomotic sessions. All 50 sessions were subjected to blind evaluation using SARMS. Primary outcomes were changes in time required to complete an anastomosis for each participant over the 5 sessions, and trends in SARMS scores for each skill area for each participant over the 5 sessions. Result: Inter-rater reliability for the SARMS instrument was excellent for all skill areas rated among the 4 expert, blinded evaluators, demonstrated by Cronback alpha scores greater than 0.9 in each category. All skill areas and overall performance improved significantly for each participant over the 5 robotic assisted micro-anastomosis sessions, and operative time decreased over the study for all participants. The results showed an initial steep technical skill acquisition followed by more gradual improvement, and a steady decrease in operative times that ranged between 1.2 hours and 9 minutes. Conclusion: The Structured Assessment of Robotic Microsurgery Skills (SARMS) is a valid instrument for assessing microsurgical skills, with good inter-rater reliability. Subjects at all levels of training from very little microvascular experience to microsurgery experts gained proficiency over the course of 5 sessions.