Prospective Validation of Robotic Surgery Simulator for General Surgeons

Beatriz Martin-Perez, MD, Sergio Larach, MD, Paula Veldhius, Lawna Hunter, BA, Pablo Arnoletti, MD, Matthew Albert, MD, Steve Eubanks, MD, Sebastian De la Fuente, MD. Florida Hospital

BACKGROUND

Several studies have shown that short-phase training on virtual simulators improves technical performance in minimally invasive surgery, allowing trainees to gain experience before embarking on clinical responsibilities. However, the utility of robotic simulators for surgeons seeking robotic surgery proficiency is less clear. The Mimic dV-Trainer® (MdVT) is a virtual reality robotic surgery simulator based upon the daVinci® surgical system. The purpose of this study was to prospectively validate the MdVT system for general surgeons.

METHODS

IRB approval was obtained at Florida Hospital Orlando. Surgeons at different stages in their careers and medical students were recruited to participate in this prospective study. Consented subjects were divided in two groups based upon their previous robotic experience: Group 1-No previous experience (NE); Group 2-Previous experience (E). Participants were asked to perform two rounds of 4 exercises each. Demographic data and performing scores were recorded. Score values were based on a 100 point scale. P values < 0.05 were considered statistically significant.

RESULTS

A total of twenty (n=20) subjects were recruited; 13 in the NE group and 7 in the E group. Experience in the E group ranged from 1 to 125 prior robotic cases. Eighty percent of the participants were males, and 80% were right-handed. The NE group was comprised of 8 medical students, 2 residents, 1 fellow and 2 attending surgeons while the E group included 4 attendings and 3 fellows. Fifty percent of the E group played video-games on a regular basis while only 38% of the NE group did. The NE group showed significantly worse baseline performance scores compared to the E group in camera targeting (29 vs 65, p=0.005) and energy dissection (39 vs 56, p=0.028). Differences in the scores between groups were still noted on the second round for peg board (66 vs 80, p=0.04) and energy dissection (42 vs 60, p=0.04). During the second round of exercises, significant improvements were noted in the NE group in peg transfer (53 vs 66, p=0.012), camera targeting (29 vs 48, p=0.029), and thread (39 vs 48, p=0.028). Improvements in accuracy were noted in the E group only for peg transfer exercise (63 vs 80, p=0.015), although most exercises were done more rapidly in the E group during the second round.

CONCLUSIONS

Repetition of exercises in a robotic simulator allowed both experienced and non-experienced operators to improve proficiency. Validation of a dedicated curriculum in robotic surgery using simulators has the potential to improve performance for surgeons interested in acquiring robotic skills.