Purpose of the Study: (1) To develop a multifaceted didactic and hands-on curriculum to prepare otolaryngology residents to perform transoral robotic surgery (TORS) and safely transition to the operating room. (2) To assess the effectiveness of the TORS curriculum. Procedures: Learning objectives were developed and a curriculum was formulated utilizing five unique modalities: focused didactic reading, online training modules, backpack console simulations, videos of TORS cases, and hands-on cadaveric dissections with the robotic surgical system in a simulated operating room. The trainees completed a nine-item self-assessment of their skill level using a Likert scale. Results: Five senior otolaryngology residents completed the TORS curriculum. Before and after the cadaveric dissections, there was improvement in each of the nine items assessed. Composite scores were calculated and there was significant improvement from predissection (15.2 ± 2.2) to postdissection (31.4 ± 1.9) (p = 0.002). Conclusions: The current study demonstrates the feasibility of implementing a multifaceted TORS curriculum which incorporates robotic cadaveric dissection for otolaryngology residents. Residents demonstrate marked improvement in skills with the TORS curriculum. A TORS curriculum which includes robotic cadaveric dissection can improve surgical skills and serve as a key component of residency TORS education.

Keywords:
Transoral robotic surgery, Surgical simulation, Robotic education, Residency training
1.
Dziegielewski PT, Teknos TN, Durmus K, Old M, Agrawal A, Kakarala K, et al: Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg 2013; 139: 1099–1108.
2.
Moore EJ, Olsen SM, Laborde RR, Garcia JJ, Walsh FJ, Price DL, et al: Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc 2012; 87: 219–225.
3.
Park YM, Byeon HK, Chung HP, Choi EC, Kim SH: Comparison study of transoral robotic surgery and radical open surgery for hypopharyngeal cancer. Acta Otolaryngol 2013; 133: 641–648.
4.
Park YM, Kim WS, Byeon HK, Lee SY, Kim SH: Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer. Br J Oral Maxillofac Surg 2013; 51: 408–412.
5.
Weinstein GS, O’Malley BW Jr, Magnuson JS, Carroll WR, Olsen KD, Daio L, et al: Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 2012; 122: 1701–1707.
6.
Choby GW, Kim J, Ling DC, Abberbock S, Mandal R, Kim S, et al: Transoral robotic surgery alone for oropharyngeal cancer: quality-of-life outcomes. JAMA Otolaryngol Head Neck Surg 2015; 141: 499–504.
7.
Mercante G, Masiello A, Sperduti I, Cristalli G, Pellini R, Spriano G: Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: a 1-year follow-up study. J Craniomaxillofac Surg 2015; 43: 1561–1566.
8.
Sharma A, Patel S, Baik FM, Mathison G, Pierce BHG, Khariwala SS, et al: Survival and gastrostomy prevalence in patients with oropharyngeal cancer treated with transoral robotic surgery vs chemoradiation. JAMA Otolaryngol Head Neck Surg 2016; 142: 691–697.
9.
Gildener-Leapman N, Kim J, Abberbock S, Choby GW, Mandal R, Duvvuri U, et al: Utility of up-front transoral robotic surgery in tailoring adjuvant therapy. Head Neck 2016; 38: 1201–1207.
10.
Smith RV, Schiff BA, Garg M, Haigentz M: The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients. Laryngoscope 2015; 125(suppl 10):S1–S15.
11.
Chen MM, Roman SA, Kraus DH, Sosa JA, Judson BL: Transoral robotic surgery: a population-level analysis. Otolaryngol Head Neck Surg 2014; 150: 968–975.
12.
Mandal R, Duvvuri U, Ferris RL, Kaffenberger TM, Choby GW, Kim S: Analysis of post-transoral robotic-assisted surgery hemorrhage: frequency, outcomes, and prevention. Head Neck 2016; 38(suppl 1):E776–E782.
13.
Sperry SM, O’Malley BW Jr, Weinstein GS: The University of Pennsylvania curriculum for training otorhinolaryngology residents in transoral robotic surgery. ORL J Otorhinolaryngol Relat Spec 2014; 76: 342–352.
14.
Curry M, Malpani A, Li R, Tantillo T, Jog A, Blanco R, et al: Objective assessment in residency-based training for transoral robotic surgery. Laryngoscope 2012; 122: 2184–2192.
15.
Sobel RH, Blanco R, Ha PK, Califano JA, Kumar R, Richmon JD: Implementation of a comprehensive competency-based transoral robotic surgery training curriculum with ex vivo dissection models. Head Neck 2016; 38: 1553–1563.
16.
Szmuilowicz E, Neely KJ, Sharma RK, Cohen ER, McGaghie WC, Wayne DB: Improving residents’ code status discussion skills: a randomized trial. J Palliat Med 2012; 15: 768–774.
17.
Wayne DB, Moazed F, Cohen ER, Sharma RK, McGaghie WC, Szmuilowicz E: Code status discussion skill retention in internal medicine residents: one-year follow-up. J Palliat Med 2012; 15: 1325–1328.
18.
Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D: SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016; 25: 986–992.
19.
Yarlagadda BB, Grillone GA: Anatomic considerations in transoral robotic surgery. 2015; in Robotic Surgery of the Head and Neck: A Comprehensive Guide (Internet). New York, Springer Science+Business Media, pp 13–27.
20.
Weinstein GS, Abuzeid WM, Khan K, O’Malley BW: Patient positioning and setup utilizing the da Vinci Robotic System. 2012; in Transoral Robotic Surgery (TORS) (Internet). San Diego, Plural Publishing, pp 25–39.
21.
Durmus K, Rangarajan SV, Old MO, Agrawal A, Teknos TN, Ozer E: Transoral robotic approach to carcinoma of unknown primary. Head Neck 2014; 36: 848–852.
22.
Granell J, Mendez-Benegassi I, Millas T, Garrido L, Gutierrez-Fonseca R: Transoral robotic surgery: step-by-step radical tonsillectomy. Case Rep Otolaryngol 2014; 2014: 497528.
23.
de Almeida JR, Park RC, Villanueva NL, Miles BA, Teng MS, Genden EM: Reconstructive algorithm and classification system for transoral oropharyngeal defects. Head Neck 2014; 36: 934–941.
24.
Han MW, Roh JL, Choi SH, Nam SY, Lee HJ, Cho KJ, et al: Prognostic factors and outcome analysis of salivary duct carcinoma. Auris Nasus Larynx 2015; 42: 472–477.
25.
Delgado R, Klimstra D, Albores-Saavedra J: Low grade salivary duct carcinoma: a distinctive variant with a low grade histology and a predominant intraductal growth pattern. Cancer 1996; 78: 958–967.
26.
Fan CY, Wang J, Barnes EL: Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma. Am J Surg Pathol 2000; 24: 579–586.
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2018
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