Can We Become Better Robot Surgeons Through Simulator Practice?

Ankit Patel, MD, Meghna Patel, PhD, ABPP, Nathan Lytle, MD, Juan P Toro, MD, Sheryl Bluestein, MBA, MHA, John Sweeney, MD, S S Davis, MD, Edward Lin, DO, MBA

Emory Endosurgery Unit, Department of Surgery

INTRODUCTION – Current prerequisites for robot surgery training include completion of simulator drills designed to demonstrate basic skill acquisition. However, there is sparse information about the construct validity of these drills as they pertain to performance and safety, such as acclimating to the camera and energy foot-pedal controls. Therefore, we focused on two critical drills that have the highest potential for preventing inadvertent injuries, camera manipulation and energy application, hypothesizing that increased repetition leads to improvement in performance.

METHODS AND PROCEDURES – This study was conducted using de-identified data collected over 7 months from the dV-Trainers® (MIMIC Technologies®) simulator at one institution. We analyzed exercises used in institutional surgical robot credentialing that focused on camera manipulation and energy use. Data were extracted from the Camera Targeting 1 and Energy Dissection 1 exercises focusing on individual metrics such as Time to Complete Exercise, Economy of Motion, Blood Volume Loss, and Misapplied Energy Time. We conducted correlation analyses between exercise repetitions and performance in complex hemorrhage control.

RESULTS – Over 13,000 overall minutes of recorded use was logged in our simulator by more than 20 unique users across all exercises. An average of 12 users performed each of the analyzed exercises with an average of 5 attempts per exercise. For Camera Targeting 1, number of attempts did not correlate with Time to Complete Exercise (r= -0.21, p= 0.09) and Economy of Motion (r= 0.06, p= 0.61). For Energy Dissection 1, there was significant correlation between number of attempts for all studied variables: Time to Complete Exercise (r= -0.50, p< 0.01), Economy of Motion (r= -0.66, p< 0.01), Blood Loss Volume (r= -0.32, p= 0.03), and Misapplied Energy Time (r= -0.30, p= 0.04).

CONCLUSION – While the use of the dV-Trainers simulator can help surgeons achieve basic familiarity with robotic surgery and its controls, the association between repetition of specific tasks to achieving significant improvement (correlation ≥ +0.6 or ≤ -0.6) of complex tasks is mixed, especially when focusing on camera manipulation and energy use. This suggests that other simulation benchmarks or training paradigms may be required to help surgeons achieve expert level.

Session: Poster Presentation

Program Number: P638

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