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Integrating Robotic Surgery in Training Residents and Fellows in Vascular Surgery: Early Insights and Challenges on a Pilot Study
Meiyi Shi, Zachary Fleming, Mounir Haurani
Eastern Carolina University, Greenville, NC
Background:With the rising use of robotic platforms in surgery, there is growing interest in extending this technology to vascular procedures. Internationally, robot-assisted aortic surgeries have shown promising outcomes, including reduced clamping and anastomosis times (Stadler et al., 2010). In the U.S., institutions like Houston Methodist are exploring clinical applications in vascular surgery. However, no formal training pathway currently exists to integrate robotic techniques into vascular surgical education. Despite over 90 general surgery graduates entering vascular fellowships annually—many with robotic experience—this experience does not always translate into vascular-specific robotic competence. This study is the first, to our knowledge, to assess the feasibility of integrating robotic skills into a vascular training curriculum by comparing performance on key vascular tasks using both open and robotic techniques.
Methods:General surgery residents (PGY2-5) and vascular surgery fellows at a tertiary care center with ACGME accredited programs were voluntarily enrolled. Participants completed two technical tasks—end-to-side (ETS) anastomosis using PTFE graft and clockface suturing (CLF)—via both open and robotic approaches (
). Tasks were modeled on the Fundamentals of Vascular Surgery curriculum. Participants also completed an anonymous pre-survey assessing their vascular and robotic experience, along with self-rated competency using a Likert scale. All procedures were recorded in a de-identified manner and evaluated using structured rubrics measuring completion time, error rates, and technical quality.
Results:Eight surgical trainees completed the study: two PGY-II, one PGY-III, four PGY-IV residents, and one vascular fellow. On average, participants had 2.4 months of vascular experience and had logged 18 robotic cases. For the ETS task, average completion times were 3.81 minutes (open) and 9.50 minutes (robotic). For the CLF task, average times were 4.47 minutes (open) and 12.86 minutes (robotic). Suture breakages occurred in 2 robotic ETS cases and 3 robotic CLF cases. Technical precision—measured by graft apposition, spacing, and needle control—was notably lower in critical segments: the heel of the ETS and the backhand portion (6 to 12 o'clock) of the CLF. These areas posed particular difficulty under robotic conditions (
).
Conclusion:This pilot study demonstrates the feasibility of integrating robotic skill assessments into vascular surgery training and highlights important differences in trainee performance between open and robotic approaches. These findings underscore that prior robotic experience in general surgery does not necessarily translate to immediate proficiency in robotic vascular techniques. Several logistical challenges such as robot simulator availability and residents participation impacted study execution and further reinforce the need for structured training. These constraints point to a critical barrier in implementing robotic skill acquisition within existing residency and fellowship structures.
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