Michael Connolly, BS, John Seligman, BA, Maurice Page, MD, Andrew Kastenmeier, MD, Matthew I Goldblatt, MD, Jon C Gould, MD
Medical College of Wisconsin, Department of Surgery, Division of General Surgery
Background: The clinical application of robotic assisted surgery (RAS) is rapidly increasing. The daVinci Surgical System™ is currently the only commercially available RAS system, and utilization is rapidly proliferating nationally. The skills necessary to perform robotic surgery are unique from those required for both open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (Fundamentals of Laparoscopic Surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool specific for robotic surgery. Based on previously published data and expert opinion, we developed a robotic skills curriculum. We sought to evaluate this curriculum for evidence of construct validity (ability to discriminate between users of different skill levels).
Methods: Four expert surgeons (defined as having performed >20 RAS) and twelve novice surgeons (second-year medical students with no surgical or RAS experience) were evaluated. The curriculum comprised five tasks utilizing the daVinci™ Skills Simulator (Pick & Place, Camera Targeting 2, Peg Board 2, Matchboard 2, and Suture Sponge 3). After an orientation to the robot and a practice period of acclimation in the simulator, all subjects completed three consecutive repetitions of each task. Computer-derived performance metrics included time, economy of motion, master work space, instrument collisions, excessive force, distance of instruments out of view, drops, missed targets (in the case of the suture sponge), and overall score (a composite of all metrics). Performance of the two groups was compared using the Wilcoxon Rank Sum test with p<0.05 considered significant.
Results: Expert surgeons significantly outperformed novice surgeons in almost all metrics. Statistically significant differences were detected for each task in regards to mean overall scores and mean time to completion.
| Task | Mean Expert Overall | Mean Novice Overall | p-value | Mean Time Expert | Mean Time Novice | p-value |
| Pick&Place | 94.9 | 91.7 | 0.03 | 27.9 sec | 45.4 sec | 0.0002 |
| Camera Target 2 | 87.2 | 62.8 | <0.0001 | 86.5 sec | 259.7 sec | <0.0001 |
| Pegboard 2 | 95.9 | 78.2 | <0.0001 | 73.1 sec | 140.3 sec | <0.0001 |
| Matchboard 2 | 81.1 | 57 | <0.0001 | 96.3 sec | 192.5 sec | <0.0001 |
| Suture Sponge 3 | 85.3 | 42 | <0.0001 | 200.4 sec | 530.6 sec | <0.0001 |
Conclusion: The curriculum we propose is a valid method of assessing and distinguishing robotic surgical skill levels on the da Vinci Si™ Surgical System.. The next step is to establish proficiency levels based on expert performance, and to see if novice surgeons can train to these levels and acquire robotic surgical skills in a simulator.
Session: Poster Presentation
Program Number: P152
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