Laparoscopic training leads to acquisition of sophisticated technical skills superfluous for the robotic environment: results of a randomized trial on virtual reality simulation platforms.

Sergio E Alonso Araujo, MD, PhD1, Alexandre B Bertoncini, MD1, Lucas A Horcel1, Victor E Seid, MD, PhD1, Sergio C Nahas, Md, PhD1, Ivan Cecconello, MD, PhD1, Conor P Delaney, MD, PhD2, Luiz Augusto C D’Albuquerque, MD, PhD3. 1Department of Gastroenterology, Division of Colon and Rectal Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil, 2Department of Surgery, Case Western Reserve University School of Medicine, 3Department of Gastroenterology, Discipline of Organ Transplantating of the Digestive Tract, University of Sao Paulo medical School, Sao Paulo, brazil

Purpose: Training surgeons to proficiency in laparoscopic and in robotic surgery is challenging. Virtual reality (VR) laparoscopic and robotic simulator training improves patient safety and operating room efficiency. However, data comparing the impact of VR training on skills acquisition remain scarce.  In the present study, we aimed at determining how does training in a robotic VR simulation platform compare to training in a laparoscopic VR simulator regarding which modality improves skills acquisition more effectively.

Methods: Sixty-three medical students (2nd to 4th year) were randomly assigned to a 4-hr intensive proctored simulator training session in a robotic (Mimic DV Trainer) or laparoscopic (Simbionix Lap Mentor) VR simulator. All participants were given a tutorial on using both laparoscopic and robotic simulators and participated in a warm-up. After randomization, students practiced to proficiency in four pre-determined skill-matched modules on each simulator. After training completion, all students executed two unpractised predetermined test tasks, one in each simulator (the first test module was taken in the simulator they have trained, the second was completed in the simulator they have not trained). The primary outcome measures were comparative performances between the two groups of participants, based on simulator scores, in both simulators. For the test module undertaken in the laparoscopic simulator, 11 score values were calculated. For the test module accomplished in the robotic simulator, only one performance score was available. Mean score values between the groups were compared.

Results: All participant students completed the study. Thirty-two were randomly assigned to training in the robotic platform; and 31, to the laparoscopic platform. Laparoscopic and robotic groups were not significantly different regarding demographic measures. For the test task undertaken in the VR laparoscopic simulator, six of eleven mean score results indicated a significant better performance for the students who trained in the laparoscopic platform. For the test module undertaken in the VR robotic simulator, mean performance scores were not significantly different between students that practiced in the robotic and in the laparoscopic platform. Residents predicted greater comfort performing surgical procedures using the platform in which they trained; however, the robotic training group liked their training more.

Conclusions: Laparoscopic VR simulator training may better teach skills that transfer to other platforms. Training on a robotic platform did not demonstrate transfer of skills to a laparoscopic platform. Robotic assistance may not teach as generalizable skills, or may be making the procedure easier, such that skills do not transfer.

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