Does surgical skill rely on surgical specialty or training method? A randomised controlled trial

Objectives
To compare training outcomes of three surgical disciplines learning a robotic suturing anastomotic skill with traditional and proficiency-based progression (PBP) training approaches.
Material and methods
The PROVESA trial is a cross-specialty, prospective, randomized and blinded clinical controlled trial comparing traditional to PBP training for basic robotic skill training. Participants were 36 robotic naïve urology (n = 12), surgery (n = 12) and gynecology (n = 12) residents. Matching for surgical specialty was done before randomization. Primary endpoint was the proficiency demonstration at the end of training, as compared between different disciplines (Gyn, Urology and Gen Surg) and training groups (Traditional Trained and the PBP trained). Differences in terms of operative errors and steps between groups were secondary endpoints.
Results
Overall, 67% of the PBP group reached proficiency and 17% of the Traditional group (p<.001). For all the surgical disciplines the PBP trained surgeons were more likely to demonstrate the proficiency benchmark after training. There was no statistically significant inter-discipline difference in performance errors in the traditional (p= .564) and PBP group (p= .894).

Conclusions
In the PROVESA trial, there were no inter-discipline differences in the performance of the robotic surgical suturing and anastomotic task. Surgical skill appeared to be determined by the training methodology, not the surgical discipline.