Reprogramming the Surgeon: Robotics and the Future of Training

European Journal of Cardio-Thoracic Surgery, vol. 68

Abstract

Over the past 2 decades, robotic-assisted thoracic surgery (RATS) has transformed from curiosity to cornerstone of thoracic surgery. Its high-definition three-dimensional vision, articulated instruments and the ergonomic freedom of the console have redefined what minimally invasive thoracic surgery could achieve. Complex lung and mediastinal resections, once the domain of thoracotomy, are now part of the robotic repertoire. But as the technology matures, a more urgent question emerges: how do we train the next generation to master it without losing the fundamentals on which thoracic surgery is built? The rapid expansion of the delivery of RATS worldwide has been well received; however, it has universally expanded faster than the robotic educational infrastructure required to support their residency programme. The evidence is striking and consistent. In the French nationwide survey of young thoracic surgeons, only 18% had ever performed a complete robotic case as primary operator, despite 78% having some simulation exposure.1 Access was heavily centre-dependent; similar to that shown in the ESTS survey, which echoed the disparity: 22% of European centres had no robot at all, 31% had limited access, and only 17% offered full access with proctoring.2 The consequence is a training environment in which enthusiasm far exceeds opportunity. Nearly three-quarters of trainees believe robotics is essential to their future, yet most will finish residency without console competency. As RATS becomes a core component of thoracic practice, this inequity poses a threat to both training quality and patient safety.

Authors 3

1. Gowthanan Santhirakumaran

   St Bartholomew's Hospital

   Affiliation as printed

   Barts Thorax Centre, St Bartholomew’s Hospital , London,

2. Ghada M. M. Shahin Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,

3. Sasha Stamenkovic corresponding

   St Bartholomew's Hospital

   Affiliation as printed

   Barts Thorax Centre, St Bartholomew’s Hospital , London,