Video-based Task Deconstruction of Robotic Hiatal Hernia Repair

Abstract Introduction: Robotic surgery is increasingly permeating the surgical arena and expanding the role of minimally invasive surgical approaches. Due to this, teaching robotic skills to general surgery residents is critically important. Standardized tools for teaching are lacking. Video based learning has demonstrated significant advancements. Video-based education addresses challenges within surgical training including increased knowledge retention within a continuously expanding field of information and a time-constrictive environment. We propose a surgical steps task deconstruction of robotic hiatal hernia repair with LINX paired with a surgical video following the same steps and using valuable video characteristics, as a standardized teaching tool. Methods: Subject matter experts (SMEs) created a list of procedural steps for a robotic hiatal hernia repair with LINX. Four SMEs developed a comprehensive ten-step task list for the conduct of the operation, beginning with a literature review and employing a modified Delphi process to reach a consensus. A surgical video was created using narration and anatomic labeling to guide the learner through the Delphi process agreed upon ten procedural steps. The goal was to create a standardized set of tasks paired with video representation to facilitate teaching robotic HHR with LINX to novice learners. Results: From an initial literature review, focus group discussions resulted in Delphi consensus on ten procedural steps, modified from the initial four steps. Creation of a video-based instruction tool with consideration for important characteristics such as narration and anatomic labeling allows for standardization of the performance and teaching of the operation, facilitating formative and summative feedback and assessment for learners by the supervising surgeon. Conclusion: Development of a standardized task list paired with video-based learning for a robotic hiatal hernia repair with LINX provides the structure for teaching complex robotic surgery safely and efficiently to general surgery residents. Video-based education offers significant advantages in trainee learning, performance, and experience therefore it should be an integral part of surgical education.