Prince and princesses: The current status of robotic surgery in surgical oncology.

Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.

How to integrate robotic training in surgical residency? An example of a 2-week robotic rotation.

General surgery residents should be proficiently trained in robotic surgery. However, there is currently no standardized robotic training curriculum. We aimed to evaluate two approaches to a robotic curriculum and how implementing a virtual reality (VR) simulation curriculum improves trainee robotic performance. From 2019 to 2022, two models of a robotic training curriculum were examined: an in-unit rotation (IUR) and a 2-week curriculum (2WR). The VR curriculum was completed using the da Vinci® Skill Simulator. The curriculum used a pre/post-test design. Residents completed a pre-test that consisted of 4 VR exercises (graded 0-100%) and 3 inanimate box trainer exercises (graded using modified Objective Structured Assessment of Technical Skills). Then, residents completed a VR curriculum of 23 modules. Following the curriculum, residents were given a post-test with the same pre-test exercises. Time necessary to complete the curriculum and compliance were recorded. Of the 11 residents who participated in the IUR, 4 completed the VR curriculum. Comparatively, 100% (n = 23) of residents in the 2WR completed the curriculum. Average time to complete the VR curriculum was 3.8 h. After completion of the 2WR curriculum, resident performance improved from pre-test to post-test: VR test scores increased (160% vs 223%, p < 0.001), OSATS scores increased (15.0 vs 21.0, p < 0.001), and time to complete inanimate exercises decreased (1083 vs 756 s, p = 0.001). Residents who mastered all modules had higher post-test VR scores (241% vs 214%, p = 0.024). General surgery residents demonstrated improved compliance with the 2WR. The VR curriculum improved resident robotic performance in both virtual and inanimate domains.

Robotic pancreas surgery for pancreatic cancer.

Since the introduction of robotic pancreas surgery in the early 2000s, there has been significant increase in the adoption of the robot to perform complex pancreatic resections. However, utilization of the robot for pancreatic cancer has lagged behind due to concern for inferior oncologic outcomes. Furthermore, research in this field has previously been limited to small, single institution observational studies. Recent and ongoing randomized control trials in robotic distal pancreatectomy and robotic pancreatoduodenectomy have aimed to address concerns regarding the use of robotic techniques in pancreatic cancer. Together, these studies suggest similar, if not improved, outcomes with a robotic approach, including shorter hospital stays, expedited recovery with less post-operative complications, and equivalent resection rates, when compared to the standard open approaches. Additionally, surgical training in robotic pancreas surgery is of equal importance for patient safety. This review summarizes the available literature on the efficacy and safety of robotic pancreas surgery for pancreatic cancer, with specific focus on robotic distal pancreatectomy and robotic pancreatoduodenectomy.