BJS, https://doi.org/10.1093/bjs/znae208, published August 2024
Dear Editor
We read with interest the recent publication from Spinelli and La Raja exploring simulation and virtual reality in robotically assisted surgery (RAS) training1. Adoption of RAS is likely to continue as technologies advance, more platforms become available and further patient benefits are established. Developing RAS training programmes is a priority to standardise learning and assessment.
Spinelli and La Raja focus on technical aspects of simulation and immersive-based training. In doing so, an opportunity was missed to address the non-technical skills that are predictive of surgical outcomes2. In RAS, the surgeon spends the majority of time away from the operating table, necessitating excellent communication skills to coordinate with the surgical team. High performing teams overcome similar challenges by emphasising closed-loop communication3. Other non-technical skills, including situation awareness and leadership, are fundamentally altered by the Human Factors and design of RAS, necessitating specific strategies for safe performance4.
Innovative educational approaches provide opportunities to blend both technical and non-technical skills into RAS training. Feedback following a simulated robotic crisis (e.g., haemorrhage), could identify aspects of technical performance (e.g., bleeding control), situation awareness (e.g., clashing robotic arms) and decision making (e.g., conversion to open). The emerging relationship between technical and non-technical skills should be a further catalyst for inclusion of both domains in RAS training.
Recent advances in surgical data science, and surgical sabermetrics5 could soon allow for automated non-technical skills assessment, in similar fashion to the data streams of technical skill currently provided by RAS platforms. This could increase reliability and objectivity of training in RAS.
Surgical outcomes are influenced by both technical and non-technical skills. Simulation and virtual reality-based interventions for RAS training must reflect the non-technical demands to allow surgeons and teams to identify development needs, maximise performance and develop the mastery that patients expect.
References
Spinelli A, La Raja C. Simulation in robotically assisted surgery and the surgical training landscape. Br J Surg. Oxford University Press (OUP); 2024 Aug 2; 111: znae208.
Doumouras AG, Hamidi M, Lung K, Tarola CL, Tsao MW, Scott JW, et al. Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises: Non-technical skills during operative crises. Br J Surg. Oxford University Press (OUP); 2017 Jul; 104: 1028–1036.
Cha JS, Athanasiadis D, Anton NE, Stefanidis D, Yu D. Measurement of nontechnical skills during robotic-assisted surgery using sensor-based communication and proximity metrics. JAMA Netw Open. American Medical Association (AMA); 2021 Nov 1; 4: e2132209.
Marcus HJ, Ramirez PT, Khan DZ, Layard Horsfall H, Hanrahan JG, Williams SC, et al. The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring. Nat Med. Springer Science and Business Media LLC; 2024 Jan 19; 30: 61–75.
Howie EE, Ambler O, Gunn EGM, Dias RD, Wigmore SJ, Skipworth RJE, et al. Surgical sabermetrics: A scoping review of Technology-enhanced assessment of nontechnical skills in the operating room: A scoping review of Technology-enhanced assessment of non-technical skills in the operating room. Ann Surg. Ovid Technologies (Wolters Kluwer Health); 2024 Jun 1; 279: 973–984.
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