The simulators are “a little more like video games,” says Murillo, who wonders if someone who has played video games their whole life could have an advantage when it comes to working on the robot.
That’s a question that has actually been studied. A 2023 study in the Journal of Robotic Surgery found that “the video game experience improves basic robotic surgery abilities,” specifically when looking at robotic surgical tasks like camera targeting, energy switching, and vertical defect suturing. Others argue that while some skills from video games might be applicable, the hand-eye coordination that you need to operate a surgical robot is different from that developed playing video games.
Asher Mandel, an associate researcher in the Department of Urology at Mount Sinai, puts it this way, “Does playing baseball help you play soccer?” In other words, while some skills from video games may help in robotic surgery, they are still very different.
While playing video games might not translate directly to robotic surgery, extensive research into the best ways to gain expertise is underway.
Murillo is spending a dedicated research year trying to answer this question. In a study funded by UCSF and Intuitive, she plans to identify the measures that can differentiate a novice robot user from a proficient one. Once she finds those measures, she will also investigate how to teach students those specific skills through new curricula.
While there is currently no single standardized curriculum for using the surgical robot, students generally practice on simulators, work as bedside assists for around 10 cases, and then transition to working on the console with the help of an attending surgeon. In the past, there has been an emphasis on the amount of time spent using simulators. But Murillo explains, “what people are starting to realize is that maybe time is not the best measure of proficiency in robotic surgery. We are looking for other factors that we can teach to make someone truly proficient on the robot.”
Additionally, experts are questioning the pros and cons of teaching using a surgical robot. Challenges include involving medical students when their main role is watching from the console, “almost like watching YouTube videos or something,” said Murillo. Issues surrounding the high cost of the robot and access to simulators are also limiting factors.
Still, there can actually be educational benefits to teaching with robotic surgery.
“Robotic surgery has actually made [education] more equal because for the first time the student can see exactly what the surgeon sees,” says Johannes Kratz, the director of minimally invasive and robotic thoracic surgery at the University of California, San Francisco. Otherwise, students may be watching from the opposite side of the patient or from an uncomfortable angle. The console allows students to have the same view as the lead surgeon.
Ashutosh Tewari, the chair of urology and director of the robotic surgery institute at Mount Sinai, echoed these sentiments. “Students can learn better because they can finally see,” says Tewari.
Tewari was involved in the first robotic prostatectomy (with his mentor, the professor Mani Menon) in 1999 and has since completed over 9000 robotic radical prostatectomy surgeries. This is a minimally invasive procedure in which the surgeon removes the prostate to treat prostate cancer. Tewari explains that exposure to robotic surgery starts from day one for students in his residency program and says he even wants to bring this kind of 3D modeling to anatomy labs for first-year medical students.
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