BJS, https://doi.org/10.1093/bjs/znae208, published August 2024
Dear Editor
We appreciate the thoughtful commentary by Dick et al. on our publication regarding the importance of integrating non-technical skills in robotically assisted surgery (RAS) training.
While our publication focused primarily on the technical aspects of simulation and immersive reality (IR)-based training, we fully support the inclusion of non-technical skills in RAS training curricula. The emphasis on the importance of non-technical skills, such as communication, environmental awareness, anticipation and teamwork is indeed critical and complements the technical aspects we focused on in our paper1. Unfortunately, assessment and reporting on non-technical skills is still scarce1. The combination of technical proficiency and consiousness of non-technical skills will undoubtedly produce more well-rounded surgeons and safer outcomes for patients.
There is also a growing need to address cognitive load management and stress resilience in RAS training. Surgeons performing minimally invasive surgery often experience heightened cognitive demands because of the complex integration of visual, motor, and decision-making tasks2. IR simulations could play a pivotal role in recreating high-pressure scenarios, not only to refine technical manoeuvres but also to enhance surgeons' ability to manage stress and maintain cognitive clarity in critical situations3.
One particular aspect in the field of communication and teamwork is the demand of heightened co-ordination between team members when dual-console training is available and during telementoring4. Simulation-based training offers an ideal platform to enhance real-time collaboration among surgeons at the console or remotely. By incorporating simulated scenarios that involve multi-console coordination, teams can practise effective communication and execution, preparing them to handle complex surgical environments with confidence.
Lastly, we want to stress that, as new robotic platforms enter the market and become more widespread, RAS training programmes must be designed with adaptability in mind. Future-proofing RAS curricula should involve modular training that accommodates the specific functionalities of various robotic systems, ensuring that surgeons can transfer their skills across different platforms without compromising patient safety or surgical efficiency.
In conclusion, while our initial publication focused on the technical aspects of simulation and virtual reality-based training, we agree with the importance of incorporating non-technical skills to create more holistic RAS training programmes. By expanding the scope of training to include cognitive load management, stress resilience, multi-surgeon collaboration, and platform-agnostic training we can better prepare the next generation of robotic surgeons for the complex demands of the operating room.
References
V. Mahendran, L. Turpin, M. Boal, and N. K. Francis. Assessment and application of non-technical skills in robotic-assisted surgery: a systematic review. Surg Endosc, vol. 38, no. 4, pp. 1758–1774. doi: 10.1007/s00464-024-10713-1.
H. N. Modi, H. Singh, A. Darzi, and D. R. Leff. Multitasking and Time Pressure in the Operating Room: Impact on Surgeons’ Brain Function. Annals of Surgery, vol. 272, no. 4, pp. 648–657, Oct. 2020, doi: 10.1097/SLA.0000000000004208.
C. D’Ambrosia et al. The physiology of intraoperative error: using electrokardiograms to understand operator performance during robot-assisted surgery simulations. Surg Endosc, vol. 37, no. 6, pp. 4641–4650. doi: 10.1007/s00464-023-09957-0.
M. Mori et al. Clinical practice guidelines for telesurgery 2022: Committee for the promotion of remote surgery implementation, Japan Surgical Society. Surg Today, vol. 54, no. 8, pp. 817–828. doi: 10.1007/s00595-024-02863-5.
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