Daniel Davila, MD, Melissa C Helm, BS, Jon C Gould, MD, Matthew I Goldblatt, MD. Medical College of Wisconsin
Introduction: General Surgery is currently the fastest growing specialty with regards to robotic surgical system utilization. Contrary to the recent experience in laparoscopy, simulator training for robotic surgery is not widely employed partly because robotic surgical simulators are expensive. We sought to determine if robotic surgical skills could be derived from those psychomotor skills attained in a validated laparoscopic simulation curriculum (Fundamentals of Laparoscopic Surgery, or FLS).
Methods and Procedures: 27 trainees with no prior robotic experience and limited exposure to laparoscopy were recruited to participate in this study. After IRB approval, they were randomly assigned to one of 3 training groups: no simulator training, training on FLS in a standard FLS video trainer, and training on a robotic computer-based simulator (da Vinci trainer). After randomization and before training, baseline robotic surgical skills were assessed in the clinical robot (not the virtual reality simulator) on 2 tasks – robotic intracorporeal suturing/knot tying and robotic peg transfer. Performance was objectively assessed using a previously validated model. Objective performance scores were calculated as follows: peg transfer score = 300 – (time to transfer all 6 pegs) – (penalty for % of pegs unable to be transferred); knot score = 300 – (time to tie knot) – (penalty for a loose or a slip knot). Following baseline assessment, subjects underwent four 1-hour long training sessions in their assigned training environment over a course of several weeks. Robotic surgical skills were reassessed on the clinical robot on the same 2 tasks used to assess skill prior to training.
Results: A one-way analysis of covariance (ANCOVA) on post-test scores using trainees’ baseline scores as the covariate, indicated a significant difference for the type of training on both knot tying (p= 0.014) and peg transfer (p=0.021) scores. FLS training resulted in a greater score improvement than no training for both knot and peg scores. FLS training was also determined to result in greater score improvement than robotic simulator training for knot tying (Table 1).
Conclusions: Robotic surgical skills can be in part derived from psychomotor skills developed in a laparoscopic trainer, especially for complex skills such as intracorporeal knot tying. Acquisition of robotic surgical skills may be enhanced by practice on a laparoscopic simulator using the FLS curriculum. This may be especially helpful in situations where a robotic simulator is not available or poorly accessible.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79558
Program Number: P283
Presentation Session: Poster (Non CME)
Presentation Type: Poster