The Balance Between Open and Robotic Training Among Graduating Urology Residents: Does Surgical Technique Need Monitoring?
A minimum number of index procedures are required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. To evaluate this, we assessed the distribution of robotic and open surgeries performed by residents upon graduation.Voluntary ACGME resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon Rank Sum and Two-Sample T-tests.89,199 major cases were recorded by 209 graduates from 2011-2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%); oncology (27.5% to 54.2%); and pediatrics (0% to 10.9%) (P for all < 0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology, the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution.Although robotic volume is increasing, the balance of surgical technique and the pace of change vastly differ in reconstruction, oncology and pediatrics as well as among individual institutions and graduates themselves. This questions whether more specific guidelines are needed to ensure equity and standardization in training.