Global Evaluative Assessment of Robotic Skills (GEARS)

Ref. Goh et al, Journal of Urology, 2012. 

GEARS is a validated assessment tool for grading overall technical proficiency for robotic surgery. While it measures domains, such as fluidity of motion, it does not define surgical or clinical judgement. Each of the six domains shown below are scored on a Likert Scale between 1 – 5, a scoring anchor, with a total score range from 6 – 30. The Autonomy domain is not scored by C-SATS due to video analysis limitations which do not allow for evaluation of verbal guidance, which means the total score achieved through the C-SATS platform could range from 5 – 25.

Depth Perception

1 - Constantly overshoots target, wide swings, slow to correct

3 - Some overshooting or missing target, but quick to correct    

5 - Accurately directs instruments in the correct plane to target

Bimanual Dexterity 

1 - Uses only one hand, ignores non dominant hand, poor coordination

3 - Users both hands, but does not optimize interaction between hands

5 - Expertly uses both hands in a complementary way to provide optimal exposure


1 - Inefficient efforts; many tentative movements; constantly changing focus or persisting without progress

3 - Slow, but planned movements are reasonably organized

5 - Confident, efficient and safe conduct, maintains focus on task, fluid progression

Force Sensitivity 

1 - Rough moves, tears tissue, injures nearby structures, poor control, frequent suture breakage

3 - Handles tissue reasonably well, minor trauma to adjacent tissue, rare suture breakage

5 - Applies appropriate tension, negligible injury to adjacent structures, no suture breakage

Robotic Control

1 - Consistently does not optimize view, hand position, or repeated collisions even with guidance

3 - View is sometimes not optimal. Occasionally needs to relocate arms. Occasional collisions and obstruction of assistant

5 - Controls camera and hand position optimally and independently. Minimal collisions or obstruction of assistant

Autonomy (NOt scored by c-sats)

1 - Unable to complete entire task, even with verbal guidance

3 - Able to complete task safely with moderate verbal guidance

5 - Able to complete task independently without verbal prompting 


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