As the number of robotic assisted surgery operations continues to increase,1 robotic surgery has been increasingly adopted into general surgery residency training, with around 75% of US general surgery training programs having formal robotic curricula2,3 compared to 60% of residents reporting no formal robotic training prior to their first robotic operation back in 2013.4 Residents are gaining learning opportunities, particularly in noncomplex robotic surgery (e.g., robotic inguinal hernia), and it has become vital to characterize residents’ competency-based education and assessment (CBEA)5 as well as progressive autonomy in robotic surgery to ensure their practice readiness. Surgical educators and professional societies have invested significant efforts in evaluating robotic proficiency such as guidelines for credentialling and competencies from the American Board of Surgeons6 and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES),7 and the SAGES Fundamentals of Robotic Surgery curriculum.8

Although operative time has been used as a surrogate for operative autonomy in open and laparoscopic surgery,9,10 2 challenges may undermine the implementation of resident CBEA and autonomy in robotic surgery. First, operative time and operative autonomy are 2 different concepts. Operative time is defined as active console control during an operation.11 Resident operative autonomy, on the other hand, consists of more components than operative time - multiple subtleties compose operative independence including technical skills, pre- and intraoperative surgical decision-making, and leadership of the operating room (OR). Second, there are limited validated objective measures for assessment of operative autonomy. Though robotic console time, which the Da Vinci Surgical System automatically records, has been validated as an accurate representation of operative time in robotic cases,11 the use of it as an objective measure to assess resident autonomy in robotic surgical training has not yet been fully explored.

We conducted this study to investigate whether resident robotic console time (RCT) is a valid surrogate measure of resident case-specific operative autonomy by answering following 2 research questions:

What is the correlation between objective resident RCT and subjective operative autonomy as evaluated by attending surgeons and residents?

What are the relationships between console time, resident intraoperative autonomy, resident training year, attending surgeon robotic experience, and operation type (cholecystectomy, inguinal hernia repair)?

Resident RCT in this study refers to the percentage of active console time per case, defined as the time when the resident's console had control over the operative arms. Our study findings would contribute an objective measure to use for surgery resident CBEA and in training curriculum development.