Robotic biotissue curriculum for teaching the robotic pancreatoduodenectomy

Minimally invasive surgery has revolutionized the face of surgical practice. Use of the robot in pancreas surgery is emerging as a feasible and effective technique. Its wide-spread implementation remains hindered by the significant learning curve. We describe how the biotissue curriculum at the University of Pittsburgh can decrease the learning curve and lead to systematic implementation of the technique. The Biotissue Curriculum is the second step of the proficiency-based robotic surgery curriculum at the University of Pittsburgh. It is comprised of suture drills and four biotissue drills: the running hepaticojejunostomy (RHJ), interrupted hepaticojejunostomy (IHJ), gastrojejunostomy (GJ) and pancreatojejunostomy (PJ). The purpose is the deliberate practice of the operative steps with frequent objective feedback for trainees toward a designated standard of proficiency. The role of the biotissue curriculum, in the context of the robotic curriculum, in mitigating the learning curve is also explored. The implementation of a training curricula that includes inanimate or biotissue practice is important for future surgical practice when adopting the robotic pancreatoduodenectomy (RPD) considering a low number of cases per trainee and the need for safe implementation of new techniques. Outcomes on robotic gastrointestinal and specifically pancreas surgery have shown feasibility and non-inferiority compared to the open approach. The biotissue curriculum in the context of the proficiency based robotic curriculum serves to help trainees achieve proficiency while mitigating the learning curve.