A new 11-item standardized assessment may help surgeons gradually reduce the learning curve as they develop the skills to perform robot-assisted microsurgery, reports a study in the October issue of Plastic and Reconstructive Surgery®.

The Structured Assessment of Robotic Microsurgical Skills (SARMS) is the first validated instrument for assessing robotic microsurgical skills. The new results suggest that surgical trainees can expect a tough going at first when they perform robot-assisted microsurgery tasks, but show gradual improvement in skills and shorter procedure times over as little as five practice sessions.

The researchers describe the development and testing of the SARMS as a standard technique for evaluating technical skills for robot-assisted microsurgery. The SARMS consisted of six items evaluating microsurgery skills and five evaluating robotic skills.

After the SARMS was validated, expert surgeons used it to grade videos of surgical trainees performing robot-assisted microvascular anastomoses. Each of nine trainees was graded on five videos, made as they gained experience with the robotic surgical system. Changes in scores in each area were assessed, along with the time required to complete the procedure.

Surgical robots including Restoration Robotics' ARTAS system for hair transplants have emerged as a potentially valuable tool in plastic and reconstructive surgery.

Surgical robots including Restoration Robotics’ ARTAS system for hair transplants have emerged as a potentially valuable tool in plastic and reconstructive surgery.

The SARMS scores documented general improvement in microsurgical skills with each practice session. On a five-point scale—from “novice” to “expert”—the trainees’ average ratings of overall skill and performance increased from around two to around four.

“The results showed an initial steep ascent in technical skill acquisition, followed by more gradual improvement,” conclude researchers who were led by Jesse C. Selber, MD, of the University of Texas MD Anderson Cancer Center, Houston. Across the five sessions, average operative time decreased gradually, from about 30 to 19 minutes, the study showed.

Previous experience performing conventional microsurgery was the main factor affecting the trainees’ skill level. The SARMS items showed good to excellent consistency among the different expert raters.