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Fundamental Skills of Robotic Surgery: A Multi-institutional Randomized Controlled Trial for Validation of a Simulation-based Curriculum

Published:February 27, 2013DOI:https://doi.org/10.1016/j.urology.2012.12.033

      Objective

      To develop and establish effectiveness of simulation-based robotic curriculum - fundamental skills of robotic surgery (FSRS).

      Methods

      FSRS curriculum was developed and incorporated into a virtual reality simulator, Robotic Surgical Simulator (RoSS). Fifty-three participants were randomized into an experimental group (EG) or control group (CG). The EG was asked to complete the FSRS and 1 final test on the da Vinci Surgical System (dVSS). The dVSS test consisted of 3 tasks: ball placement, suture pass, and fourth arm manipulation. The CG was directly tested on the dVSS then offered the chance to complete the FSRS and re-tested on the dVSS as a crossover (CO) group.

      Results

      Sixty-five percent of participants had never formally trained using laparoscopic surgery. Ball placement: the EG demonstrated shorter time (142 vs 164 seconds, P = .134) and more precise (1.5 vs 2.5 drops, P = .014). The CO took less time (P <.001) with greater precision (P <.001). Instruments were rarely lost from the field. Suture pass: the EG demonstrated better camera utilization (4.3 vs 3.0, P = .078). Less instrument loss occurred (0.5 vs 1.1, P = .026). Proper camera usage significantly improved (P = .009). Fourth arm manipulation: the EG took less time (132 vs 157 seconds, P = .302). Meanwhile, loss of instruments was less frequent (0.2 vs 0.8, P = .076). Precision in the CO improved significantly (P = .042) and camera control and safe instrument manipulation showed improvement (1.5 vs 3.5, 0.2 vs 0.9, respectively).

      Conclusion

      FSRS curriculum is a valid, feasible, and structured curriculum that demonstrates its effectiveness by significant improvements in basic robotic surgery skills.
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      References

        • McCulloch P.
        • Mishra A.
        • Handa A.
        • et al.
        The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre.
        Qual Saf Health Care. 2009; 18: 109-115
        • Vincent C.
        • Neale G.
        • Woloshynowych M.
        Adverse events in British hospitals: preliminary retrospective record review.
        BMJ. 2001; 322: 517-519
        • Leape L.L.
        Errors in medicine.
        Clin Chim Acta. 2009; 404: 2-5
        • Guru K.A.
        • Hussain A.
        • Chandrasekhar R.
        • et al.
        Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons.
        Can J Urol. 2009; 16 ([discussion: 4741]): 4736-4741
        • Kneebone R.L.
        Practice, rehearsal, and performance: an approach for simulation-based surgical and procedure training.
        JAMA. 2009; 302: 1336-1338
        • Guru K.A.
        • Kuvshinoff B.W.
        • Pavlov-Shapiro S.
        • et al.
        Impact of robotics and laparoscopy on surgical skills: a comparative study.
        J Am Coll Surg. 2007; 204: 96-101
        • Seixas-Mikelus S.A.
        • Adal A.
        • Kesavadas T.
        • et al.
        Can image-based virtual reality help teach anatomy?.
        J Endourol. 2010; 24: 629-634
        • Linstone H.A.
        • Turoff M.
        The Delphi method: techniques and applications. Reading.
        Addison-Wesley Publishing Co., Advanced Book Program, Massachusetts.1975
        • Seixas-Mikelus S.A.
        • Kesavadas T.
        • Srimathveeravalli G.
        • et al.
        Face validation of a novel robotic surgical simulator.
        Urology. 2010; 76: 357-360
        • Seixas-Mikelus S.A.
        • Stegemann A.P.
        • Kesavadas T.
        • et al.
        Content validation of a novel robotic surgical simulator.
        BJU Int. 2011; 107: 1130-1135
        • Abboudi H.
        • Khan M.S.
        • Aboumarzouk O.
        • et al.
        Current status of validation for robotic surgery simulators - a systematic review.
        BJU Int. 2012; ([Epub ahead of print])
        • Liss M.A.
        • Abdelshehid C.
        • Quach S.
        • et al.
        Validation, correlation, and comparison of the da Vinci Trainer(™) and the da Vinci Surgical Skills Simulator(™) using the Mimic(™) software for urologic robotic surgical education.
        J Endourol. 2012; 26: 1629-1634
        • Kelly D.C.
        • Margules A.C.
        • Kundavaram C.R.
        • et al.
        Face, content, and construct validation of the Da Vinci Skills Simulator.
        Urology. 2012; 79: 1068-1072
        • Lee J.Y.
        • Mucksavage P.
        • Kerbl D.C.
        • et al.
        Validation study of a virtual reality robotic simulator–role as an assessment tool?.
        J Urol. 2012; 187: 998-1002
        • Dulan G.
        • Rege R.V.
        • Hogg D.C.
        • et al.
        Content and face validity of a comprehensive robotic skills training program for general surgery, urology, and gynecology.
        Am J Surg. 2012; 203: 535-539
        • Korets R.
        • Mues A.C.
        • Graversen J.A.
        • et al.
        Validating the use of the Mimic dV-trainer for robotic surgery skill acquisition among urology residents.
        Urology. 2011; 78: 1326-1330
        • Hung A.J.
        • Patil M.B.
        • Zehnder P.
        • et al.
        Concurrent and predictive validation of a novel robotic surgery simulator: a prospective, randomized study.
        J Urol. 2012; 187: 630-637
        • Guru K.A.
        Editorial comment.
        J Urol. 2011; 186: 1024
        • Guru K.
        • Menon M.
        How do we improve techniques in robotic surgery?.
        J Urol. 2011; 185: 1186-1187