Fundamental Skills of Robotic Surgery (FSRS): A randomized controlled trial for validation of a simulation-based curriculum

K. Ahmed, A. Stegemann, J. Syed, S Rehman, K. Ghani, R. Autorino, M. Sharif, A. Rao, Y. Shi, G. Wilding, J. Hassett, A. Chowriappa, T. Kesavadas, J. Peabody, J. Kaouk, K. Guru

Roswell Park Cancer Institute, Buffalo; MRC Centre for Transplantation, Guy’s Hospital, Kings College; Henry Ford Health System; University at Buffalo

Objectives

This multi-institutional study aims to develop and establish effectiveness of simulation-based robotic curriculum – “Fundamentals Skills of Robotic Surgery” (FSRS). Feasibility and acceptability of the curriculum was also established.

Methods
FSRS curriculum was developed by Delphi process (content validation). This content validated curriculum was incorporated into a previously validated virtual reality simulator, Robotic Surgical Simulator (RoSS). Fifty-three participants were randomized into either an Experimental Group (EG; n=23) or Control Group (CG; n=30). Trainees in the EG were asked to complete the FSRS and 1 final test session on the da Vinci Surgical System (dVSS). The FSRS curriculum took 4 hours to complete and was conducted over a 1-3 week period. The dVSS test consisted of three tasks: Ball Placement, Suture Pass, and 4th Arm Manipulation. Videos of performance on these tasks were analyzed for time to complete, errors, and optimal machine usage. Trainees in the CG were directly tested on dVSS and were offered the chance to complete the FSRS and re-tested on dVSS as a Crossover group (CO; n=23). Feasibility and acceptability criteria were established through quantitative surveys.

Results
Seventy-seven percent trainees were 25-40 years of age and 65% had never been formally trained for laparoscopic surgery. Only 29% had worked on a surgical console in the past. 78% of participants felt RoSS would help them prepare for surgical training. Ball Placement: EG demonstrated shorter completion time (142 vs. 164 sec; p=0.134) and was more precise during the task compared to CG (1.5 vs. 2.5 drops; p= 0.014). The CO group took less time (p<0.001) to complete this task with significantly greater precision after finishing the FSRS curriculum (p<0.001). Instruments were rarely lost from the field after completing the FSRS curriculum. Suture Pass: EG group demonstrated better camera utilization (4.3 vs. 3.0; 0.078). Instrument loss from field of vision occurred less frequently for EG (0.5 vs. 1.1; 0.026). Proper camera usage significantly improved after completion of FSRS curriculum (p=0.009). Fourth Arm Manipulation: EG took less time to complete (132 vs. 157 sec; p=0.302). Meanwhile, loss of instruments outside training field was less frequent in the EG (0.2 vs. 0.8: p= 0.076). Precision in the CO group improved significantly after completing the FSRS curriculum (p=0.042), and camera control and safe instrument manipulation also showed improvement at completion (1.5 vs. 3.5; 0.2 vs. 0.9).

Conclusions
Fundamentals Skills of Robotic Surgery (FSRS) curriculum is a valid, feasible and structured curriculum that demonstrates its effectiveness by significant improvements in basic robotic surgery skills of the participants.

Session: Poster Presentation

Program Number: ETP020