The need for adaptive laparoscopic training, depending on conventional and robotic procedures. Evidence from an experimental profiling study

BACKGROUND: The rise in robotic surgical procedures underscores the need for effective training in minimally invasive surgery, particularly the interactions between robotic and conventional techniques. Aim of this experimental study was to examine whether conventional and robotic laparoscopy require different neuropsychological skills and to evaluate the role of individual experience and expertise. STUDY DESIGN: A single center, randomized crossover training trial was conducted at a university hospital surgical training center. Participants were 86 postgraduates (residents and experts) from general surgery, urology and gynecology who were enrolled in surgical training courses, and 237 fifth-year medical students participated within their gynecology curriculum. Participants underwent neuropsychological testing, followed by surgical training in both conventional and robot-assisted laparoscopy, performing identical tasks six times in a randomized crossover setting. RESULTS: For conventional laparoscopy, 57 participants were "slow learners," while 212 were "fast learners". For robotic laparoscopy, 193 participants were "slow learners" and 76 "fast learners". Among students, conventional training success was significantly associated with neuropsychological factors such as personality, motivation, psychomotor skills, while robotic training was predominantly associated with personality factors. Among physicians, both personality and psychomotor skills were critical for learning surgical skills in both techniques. CONCLUSION: Surgical training outcomes differ significantly between conventional and robotic laparoscopy. Conventional laparoscopy supports faster learning, with a good start performance strongly influencing training success, whereas good robotic start performance correlated with slower learning. Different individual factors influenced effective training of surgical skills according to the surgical method and prior experience and skills level, suggesting tailored training curricula. TRIAL REGISTRATION: The study is registered in The UK´s Clinical Study Registry (ISRCTN79269632).