A Multi-institutional Randomized Controlled Trial of an Augmented-Reality skill acquisition module for Robot-assisted Surgery

K. Ahmed, A. Chowriappa, R. Din, E. Field, S. Raza, A. Fazili, D. Samarasekera, J. Kaouk, L. Eichel, J. Joseph, A. Ghazi, J. Mohler, J. Peabody, D. Eun, Y. Shi, G. Wilding, T. Kesavadas, K. Guru

Roswell Park Cancer Institute Guy’s Hospital London; Henry Ford Hospital

Aim
To develop and validate a novel augmented reality based module for urethra-vesical anastomosis (UVA) during robot-assisted surgery utilizing the Hands on Surgical Training (HoST) Software.

Materials and Method
HoST integrates Augmented Reality (AR) and haptics to guide the trainee through real time operative steps in an immersive cognitive environment. This prospective, single-blinded randomized controlled trial allocated participants across three institutions to the HoST Group (HG) or the Control Group (CG). Da Vinci Surgical System (dVSS) was considered as the gold standard (for concurrent validity) and final evaluation to assess skills improvement after the educational interventions were made on the dVSS. After the initial video introduction of anastomosis, the CG performed the final UVA task using the dVSS. The HG performed HoST-based UVA module on the Robotic Surgical Simulator (RoSS) five times before performing the final UVA task on the dVSS. As part of the Cross Over Group (COG) participants in the CG were offered the opportunity to enroll to the HG. Following enrolment they re-performed UVA on the dVSS. All tasks were video recorded. The outcome parameters were evaluation of feasibility, acceptability, face, concurrent validity and stress-level (NASA Task Load Index questionnaire of the AR UVA anastomosis model). Independent-blinded robotic surgeons (~ 500 cases) evaluated the skills using validated task-specific scale and the Global Evaluation and Assessment of Robotic surgery Skills (GEARS) scale.

Results
22 surgeons (M 17; F 5) participated in the study. 71% found the HoST very close to the real surgical procedure (face validity). 82% felt the HoST to be an effective educational mode for learning procedural steps efficiently and safely. Significant differences in performance of Needle Driving (2.2 vs. 3.0; p 0.045) and Needle Positioning (2.2 vs. 2.8; p 0.033) was noted in the HG in comparison to CG when evaluated using task-specific scale. On the GEARS scale the HG obtained a significantly higher score in comparison to CG (14.4 vs. 10.5; p 0.012). Additionally, the NASA Load index test (stress-level evaluation) indicated a trend (cross over participants) towards lower scores in temporal demand (5.6 vs. 9.0; p 0.063) and effort (5.8 vs. 10.3; p-value 0.063) in comparison to the CG, thus demonstrating lesser mental fatigue.

Conclusions
Participation in augmented reality based urethro-vesical Anastomosis training resulted in improved technical knowledge and skill acquisition when tested on gold standard i.e. the dVSS. HoST is a feasible, reliable and valid training tool with acceptable educational impact.

Session: Poster Presentation

Program Number: ETP023