Ahmed M Zihni, MD, MPH, Angelia Declue, CST, Debbie Tiemann, RN, Shuddhadeb Ray, MD, Robert Wang, BS, Zhe Liang, BS, Michael M Awad, MD, PhD. Washington University in St Louis
Background: Robotic platforms offer potential advantages to surgeons performing complex laparoscopic tasks, and continue to expand among surgical modalities. Training and evaluation of trainees in robotic skills continues to increase in importance. Our group has shown that transferability of skills between laparoscopic and robotic platforms is limited, necessitating robot-specific skills curricula. Often, surgical trainees have little access to robotic platforms for training purposes. Simulator-based robotic curricula offer a safetraining option that overcomes most logistical and patient-safety hurdles. To date, however, few reports have examined the performance outcomes in a live operative setting associated with simulator-based robotic skills training. In this study, our group introduced a simulator-based robotic skills curriculum and quantified improvements in performance metrics and subjective work load associated with its use.
Methods: Surgical residents and fellows naïve to robotic platforms were enrolled in the study. Subjects performed a pre-training robot-assisted laparoscopic surgical case with experienced robotic surgeons. Performance metrics were assessed by attending surgeons using a robot-specific modification of the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Subjects rated their workload using the validated NASA task load index (NTLX). Subjects then trained to pre-set proficiency goals with the daVinci® Skills Simulator™ using a novel skills curriculum. Subjects performed a post-training case with the same attending surgeon, and O-SCORE and NTLX assessments were repeated. Pre- and post-training outcome data were compared with paired student’s t-test.
Results: Eleven subjects completed the curriculum as well as pre- and post-training cases. Completion of the curriculum was associated with improvement in camera control (2.3 pre, 4.8 post p<0.001), needle control (2.0 pre, 4.0 post p=0.002), tissue handling (2.3 pre, 4.1 post p<0.001), and overall performance (2.1 pre, 4.1 post p=0.001) as quantified by the O-SCORE assessment. Completion of the curriculum was associated with improvements in physical demand (5.1 pre, 2.8 post p=0.02), effort (6.7 pre, 4.4 post p=0.002), and frustration (6.0 pre, 1.7 post p<0.001) as quantified by the NTLX assessment.
Conclusion: In this pilot study, we have shown that a simulator-based robotic skills curriculum is associated with significant improvements in performance metrics and workload in a live operative setting. These findings highlight the importance of simulation in training robotic surgeons. Future studies will focus on optimizing curricula and assessing their use in additional trainees with blinded evaluators.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79798
Program Number: P303
Presentation Session: Poster (Non CME)
Presentation Type: Poster