A recent survey of current general surgery residents in the United States showed that more than 96% of respondents were training at an institution where a surgical robotic was available [4]. With continued interest and increase in surgical case volumes at these centers, training general surgery residents to use the robotic platform is necessary to keep up with current trends. Obtaining the appropriate level of training to safely perform robotic surgery varies based on the technical aspects related to different specialties and operations being performed. However, fundamental knowledge of how the robot works, attaining technical experience, and knowledge of troubleshooting are of utmost importance. Over the past few decades, since the adoption of laparoscopy, the Fundamentals of Laparoscopic Surgery (FLS ) has been developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES ) to ensure that all general surgery trainees have a minimum understanding and the ability to demonstrate a basic grasp of laparoscopic skills. More recently, a similar certification process for acquiring basic endoscopic skills, the Fundamentals of Endoscopic Surgery (FES ), has emerged. FLS and FES certifications are now required by the American Board of Surgery (ABS ) for all general surgery trainees to be eligible for board certification. No such curriculum currently exists for robotic surgery, but societies like the American Society of Colon and Rectal Surgeons (ASCRS ), Society for Robotic Surgery (SRS ), and SAGES are taking the lead to develop a similar, unified program.

As the da Vinci system is presently the only commercially available robotic platform with FDA approval, we will base our discussion on this system. Currently and in the past, Intuitive Surgical offers a robotic training certification course to all surgeons or trainees new to the platform. The components of the course include completing online training modules, a systems overview course, simulator exercises, and case observations, all of which could take months to complete. This is followed by a course that costs approximately $5000 USD and spans 2 days, during which time participants engage in didactic lectures, live instruction, simulation practice, and some degree of case performance on cadaveric or porcine specimens. At the end of the course, Intuitive issues a certificate stating that you have successfully completed their basic requirements for knowing how to use their platform. The certification does not make any mention (nor does it intend to) in any way that one can safely perform robotic surgery from a medicolegal standpoint. That decision is usually deferred to the surgeon’s hospital credentialing committee or robotics steering committee.

As mentioned before, there are no established protocols or minimum requirements for robotic training in general surgery residency, but several academic institutions across the country have attempted to develop a protocol or curriculum to expose their trainees to basic robotic technology [5, 6]. Training of new robotic surgeons should entail both technical and nontechnical skills, including decision-making, troubleshooting, and effective communication [7]. Protocols may vary based on the specialty and should ideally be individualized based on level of training, technical proficiency, and procedures. However, we recommend that at a minimum, basic training in robotic skills should include the following:

On Line training —Intuitive Surgical provides free online interactive training modules that introduce learners to the various components of the robotic platform, common applications, and troubleshooting tips. Modules contain questions that assess retention of relevant information and trainees are issued a certificate of completion after all modules have been successfully completed with a minimum allotted score (https://​www.​davincisurgeryco​mmunity.​com/​).

Console-based simulation training —learners should next proceed to simulation training to obtain hands-on experience with the functionality of the robotic platform. Simulation allows for progress through the learning curve and has been shown to be transferable to the clinical setting [8]. Several simulators are available (See below section on Virtual Reality Simulation for further details), and all have a variety of exercises dedicated to technical training for camera clutching, instrument manipulation and switching, tissue handling, and use of surgical energy.

Bedside training —under supervision, learners should be aware of all aspects involved with proper and optimal setup to provide safe and efficient care while being able to maximize the utility of robotic technology. Bedside training should include, but not limited to, instruction on the following:

As a sample curriculum, we have included the following requirements in place for surgical residents at the author’s institution:

If a resident or fellow successfully completes all the above, they will graduate with an equivalency certificate issued by Intuitive which is also endorsed by our general surgery program director. This eliminates the need to perform basic training in the future and graduates can apply for credentials immediately.