Robotic bedside assistance: When surgical evolution outruns regulation.

Methods and Priorities of Robotic Surgery Training Program

Background: Acute telestroke evaluations rely on the ability to rapidly and accurately calculate the NIH Stroke Scale. Remote visual field deficit (VFD) testing is often challenging, requiring trained bedside assistance particularly in rural hospital settings. These deficits account for up to 3 points on the NIHSS, which is enough to affect treatment decisions and impact outcomes. Objective: To create a simple, rapid, and robust screening telemedicine peripheral device to standardize visual field testing during acute telestroke consults and to reduce reliance on bedside assistants for this task. Methods: A one-size-fits-all device was designed such that an LED stimulus is located in each quadrant of the peripheral visual field. Bioengineers, neuro-ophthalmologists, and vascular neurologists collaborated in the development of the prototype. A randomized investigator-blinded pilot clinical trial is in progress. Stroke patients with fully-mapped visual fields were selected. The device, in the form of glasses, is easily placed on the patient’s face, and LED lights are flashed in the standard 8 fields, via a repeatable algorithm, during a simulated acute telestroke encounter. Lights are visible to the remote teleprovider for interpretation of the responses. Patients and examiners will be surveyed for feedback on ease of use of the device (primary outcome). Results from device will be compared to in-person confrontational testing and to previously recorded Humphrey mapped deficits in this same patient population (secondary). Validation is set at a sensitivity of 90% compared to confrontational or to the Humphrey static visual field test results. Results/Conclusion: Remote testing of VFDs in acute telestroke patients is difficult, especially in smaller community rural hospitals. We developed a simple and rapidly applied facial device that can assist the teleprovider in VFD evaluations, potentially affecting treatment options of thrombectomy, thrombolytics, or transfer. An on-going pilot study will test the sensitivity of the device against confrontational and static VF assessments. Innovative telestroke peripherals represent the future of the next generation of diagnostic tools specifically engineered fo remote acute stroke patient evaluations.

Making the Jump: A Qualitative Analysis on the Transition From Bedside Assistant to Console Surgeon in Robotic Surgery Training

Robotic surgery bedside assistants play an important role in robotic procedures by performing intra-corporeal tasks while accommodating the physical presence of the robot. We hypothesized that an augmented reality headset enabling 3D intra-corporeal vision while facing the surgical field could decrease time and improve accuracy of robotic bedside tasks. Bedside assistants (one physician assistant, one medical student, three surgical trainees, and two attending surgeons) performed validated tasks within a mock abdominal cavity with a surgical robot docked. Tasks were performed with a bedside monitor providing 2D or 3D vision, or an optical see-through head-mounted augmented reality device with 2D or 3D vision. The effect of augmented reality device resolution on performance was also evaluated. For the simplest task of touching a straw, performance was generally high, regardless of mode of visualization. With more complex tasks, including stapling and pulling a ring along a path, 3D augmented reality decreased time and number of errors per task. 3D augmented reality allowed the physician assistant to perform at the level of an attending surgeon using 3D augmented reality (p = 0.08). All participants had improved times for the ring path task with better resolution (lower resolution 23 ± 11s vs higher resolution 14 ± 4s, p = 0.002). 3D augmented reality vision with high resolution decreased time and improved accuracy of more complex tasks, enabling a less experienced robotic surgical bedside assistant to function similar to attending surgeons. These data warrant further study with additional complex tasks and bedside assistants at various levels of training.

A major limitation to robotic training internationally is sufficient access to console and bedside operating time. It is important that trainees are “robot ready” when clinical opportunities arise. Delivering the didactic component of training in advance of hands-on training opportunities is needed to maximise the efficiency of console time. This study describes the development and implementation of a platform agnostic online curriculum (Foundations in Robotic Surgery -IMRA) that provides an overview of robotic surgery as didactic learning prior to hands-on experience. Curriculum development is reported using Kern’s model. A literature review was conducted in accordance with the PRISMA statement. A mixed-methods approach, incorporating surveys and semi-structured interviews, defined learning objectives and curriculum content. Curriculum outcomes were assessed via surgeon surveys, and modifications were made based on feedback from the Royal Australasian College of Surgeons. The literature review revealed a gap in vendor-neutral online curricula for robotic surgery. Six experts comprising of general surgeons and urologists, identified key learning objectives on safety, communication, and surgical technique. This gap was addressed by developing an online curriculum comprising of ten theory modules. In the development group (n = 28; 16 responses), Kirkpatrick assessment showed a 60% increase in participants rating their knowledge as good or excellent. Confidence in bedside assistance and console training rose by 37.5%. In the rollout group (n = 108; 88 responses), 89.8% rated the content quality as good or excellent. Development and implementation of the IMRA Foundations in Robotic Surgery Curriculum demonstrated improvements in learners’ self-rated knowledge and confidence in both bedside and console aspects of multi-platform robotic surgery.

ObjectiveAn objective assessment of robotic assistance in hemicolectomies.BackgroundRobotic assistance has been objectively shown to be superior to conventional laparoscopy in anterior resections. This follow‐up study analyzes the role of robotics in hemicolectomies.MethodsOperative videos of laparoscopic and robotic hemicolectomies were reviewed. Only oncological resections were included. Two components were evaluated – scope holder performance and assistant instrument performance.ResultsA total of 40 videos were reviewed. The cases were stratified in equal numbers based on method of surgery (robotic, laparoscopic), type of hemicolectomy (right, left), and seniority of the bedside assistant (specialist, non‐specialist). The views achieved in robotic surgery were superior and less dependent on the bedside assistant. The degree of assistance provided by the robotic system was also more than that in the conventional laparoscopic group.ConclusionsRobotics provides superior visualization and more dynamic assistance than conventional laparoscopy in hemicolectomies. This study demonstrates the technical advantage of robotic assistance, but not necessarily a superiority in clinical outcome.

Current status of robotic assisted pelvic surgery and future developments

The dawn of the era of single incision minimally invasive surgery, or single port surgery, was first realized with laparoscopy. Beginning with simple procedures surgeons began to apply this concept to a growing variety of procedures. Despite demonstrating its feasibility and associated favorable patient outcomes, single port laparoscopy remained a challenging procedure and was unsuccessful in gaining significant traction. With the addition of the robotic surgery, single port surgery was dramatically changed. With the aid of the robotic platform, surgeons were able to overcome the challenges and limitations of laparoscopy. Since the first reports of robotic assisted single port surgery in 2009, surgeons across all specialties and subspecialties have found application in their practice. In this review, we highlight the last decade of single site robotic surgery and discuss the current challenges.

Incorporating a Detailed Case Log System to Standardize Robotic Colon and Rectal Surgery Resident Training and Performance Evaluation

Survey on Surgical Instrument Handle Design

"Background: Robotic surgery currently offers a number of benefits in specific areas of plastic and reconstructive surgery such as head and neck and microsurgery, however, many subspecialties are yet to benefit from robotic operating techniques. In this paper we review recent developments in the use of robotics for head and neck, breast reconstruction, microneural, lymphoedema, craniofacial and aesthetic surgery. Methods: A literature review of English-only articles on the use of robots in plastic and reconstructive surgery was conducted using the PubMed and Web of Science databases along with a free text search using the terms ‘robotic surgery plastic surgery’, ‘robotic-assisted plastic surgery’, ‘robot-assisted reconstructive surgery’, ‘da Vinci plastic surgery’, ‘da Vinci reconstructive surgery’ and ‘supermicrosurgery’. No limitation was placed on time from publication. Results: Of the studies reviewed, the most beneficial to reconstructive surgery is the area of the head and neck, with the most common procedures being transoral surgeries and microvascular procedures. Robotic assisted breast reconstructive surgery is a promising field. The main current limitations are the lack of adequate microsurgical instrumentation and the prolonged setting-up and operative time. Conclusion: As technology improves the outlook for robotic surgery is optimistic. Areas like microsurgery, head and neck, cleft palate, breast reconstructive surgery, lymphatic and microneural surgery already demonstrate promising results. Further technological advances and evidence-based studies are necessary to address current limitations such as appropriate microsurgical instrumentation, high costs and prolonged operative time."

The second half of the twentieth century witnessed the introduction and relatively rapid expansion of industrial robots. On the other hand, robotic infiltration in healthcare has been much slower and more limited. The past decade has experienced a surge in robotic assistance in surgery, sparked by unprecedented interest in the precision and ergonomic benefits of this rapidly evolving class of technology. While robots have been introduced more broadly in surgical fields such as urology, general surgery, and gynecology, adoption in orthopedic surgery is only recently, but rapidly, expanding and likely will remain on the leading edge of the robotic revolution.

Emergence of robotic assisted surgery in gynecologic oncology: American perspective

Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word "robotic surgery training curriculum." We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4-6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.

Background Robotic surgery is increasingly adopted across general surgical units in the United Kingdom, yet training opportunities remain inconsistent. This study explored the experiences, attitudes, and perceived barriers to robotic training among General Surgery higher surgical trainees in the East of England (EoE) deanery, with the aim of identifying areas for improvement to enhance future training provision. Methods A cross-sectional mixed-methods electronic survey was distributed to all ST3–ST8 General Surgery trainees in the EoE deanery (May–August 2025). Eligible participants were in a clinically active general surgical rotation within an EoE hospital. The 27-item questionnaire examined professional background, exposure to robotic surgery, and perceptions of training. Results Of 81 eligible trainees, 48 responded (59%), with representation from all 16 hospitals, 13 of which performed robotic procedures. Almost all respondents (98%) believed that robotic surgery would become integral to general surgical practice, and 77% intended to undertake a fellowship in robotic surgery. Twenty-seven trainees were in firms performing robotic cases, with a median exposure of one operating session per week. Satisfaction with training was low (mean 3.8/10). Independent console operating was rare (7%), with limited access to simulation (23%), structured induction (17%), and robotic courses (52%). Conclusions Trainees view robotic surgery as a valuable skill, yet current training opportunities are inadequate, inequitable and show marked variation between hospitals. Priorities for improvement include national curriculum integration, equitable access to simulation and formal training courses, and expansion of dual console operating to support safe progression from bedside assistance to independent practice.