Development of a Virtual Reality Robotic Surgical Curriculum Using the Da Vinci SI Surgical System

Pedro P Gomez, MD, Ross E Willis, PhD, Kent R Van Sickle, MD. University of Texas Health Science Center at San Antonio.

Introduction:
Prior literature has shown content and construct validity for the “da Vinci skills simulator” package available in the “da Vinci Si system”. It is unclear which of the many provided virtual reality (VR) modules are useful for skills evaluation or how many training trials are necessary to reach the manufacturer’s preset proficiency goal of 80%. This study aimed to develop a training curriculum to evaluate the basic robotic skills necessary to reach this preset proficiency score and correlate the level of surgical experience with the overall performance obtained using this simulator.

Methods and procedures:
Twenty-two participants (4 faculty, 4 senior, and 14 junior residents) were enrolled in a 4 week VR robotic training curriculum developed at our institution. A set of seven robotic skills (table 1) were selected based on the manufacturer’s exercise primary endpoint.

During their pretesting session, participants completed one trial of each of the seven selected robotic exercises. In two individual sessions over a two week period, trainees practiced a different set of exercises that evaluated the same basic robotic skills assessed during pretesting with the objective of reaching an overall score of 80% on two consecutive attempts. If proficiency was not achieved, then a maximum of 6 trials per exercise was allowed before advancing to the next simulated skill. During their fourth week of training, participants completed a post-testing session that used the same set of exercises that were used during pre-testing. Participants’ overall performance and various metrics were recorded in an online database for further analysis.

Results:
A significant skills gain from pre- to post-test was observed for each of the seven basic robotic skills regardless of participant’s level of training (p<.001). Interestingly, participants achieved an overall score of 80% or more on only five of the seven exercises suggesting that more complex skills will require more than 6 practice trials to reach the preset proficiency score. Additionally, no statistical difference in gain of skills was found between groups suggesting robotic skills development is independent of level of expertise.

Table 1

Skill Robotic Skill Pre-testing Overall Score % Post-testing Overall Score % No. Trials to Proficiency P value
  1 Camera control          72.5           90           3 <.001
  2 Energy control           68          84.5           2 <.001
  3 Endowrist manipulation           86           96           2 <.001
  4 Basic needle driving           54           80           3 <.001
  5 Advanced needle driving          50.5          73.5           6 <.001
  6 Needle control          71.5           85           2 <.001
  7 4th arm control          30.5           69           6 <.001

Conclusion:
A dedicated virtual reality robotic training curriculum significantly improves the seven basic robotic surgical skills necessary to operate the da Vinci Si surgical console. Nonetheless, more than 6 training trials appear to be necessary to reach proficiency levels on more advanced skills.

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