Quality over quantity: early performance predicts suturing proficiency in robotic surgery simulation

Abstract Robotic surgery training increasingly relies on simulation-based curricula and objective performance metrics; however, it remains unclear whether early simulator performance predicts later proficiency in complex robotic tasks. This retrospective observational cohort study analyzed simulation training data from the Simulation Center of Santa Casa de Porto Alegre, Brazil, collected between 2020 and 2024. Early-stage training metrics included time, repetitions, and mean performance scores in the Basic, Essential, and Fundamentals modules, while the primary outcome was the final simulator-derived Suture Score. Correlation analyses were performed to assess the association between prior training trajectory and final suturing performance. Fifty-seven participants were included. Mean performance scores in the Basic and Fundamentals modules were significantly associated with shorter suturing time (r = −0.269, p = 0.043 and r = −0.325, p = 0.014, respectively). Mean score in the Basic module was also associated with a higher final Suture Score (r = 0.277, p = 0.037). In contrast, total simulation time and number of repetitions showed no significant correlation with final proficiency (all p > 0.05). These findings suggest that early simulator performance scores may be more informative than training duration alone in predicting proficiency in complex robotic suturing and support the development of individualized, performance-based robotic training pathways.