Validating the Use of the Mimic dV-trainer for Robotic Surgery Skill Acquisition Among Urology Residents
Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. Urology
(Impact Factor: 2.19).
12/2011; 78(6):1326-30. DOI: 10.1016/j.urology.2011.07.1426
To compare robotic surgery skill acquisition of residents trained with Mimic dVTrainer (MdVT) and da Vinci Surgical System (dVSS) console. No standardized curriculum currently exists for robotic surgical education. The MdVT is a compact hardware platform that closely reproduces the experience of the dVSS.
Sixteen urology trainees were randomized into 3 groups. A baseline evaluation using dVSS was performed and consisted of 2 exercises requiring endowrist manipulation (EM), camera movement and clutching (CC), needle control (NC), and knot-tying (KT). Groups 1 and 2 completed a standardized training curriculum on MdVT and dVSS, respectively. Group 3 received no additional training. After completion of the training phase, all trainees completed a secondary evaluation on dVSS consisting of the same exercises performed during baseline evaluation.
There was no difference in baseline performance scores across the 3 groups. Although Group 3 showed no significant improvement in EM/CC domain (P = .15), Groups 1 and 2 had statistically significant improvement in EM/CC domain (P = .039 and P = .007, respectively). The difference in improvement between Groups 1 and group 2 was not statistically different (P = .21). Only Group 2 trainees showed significant improvement in the NC and KT domains during secondary evaluation (P = .02).
Curriculum-based training with MdVT or dVSS significantly improves robotic surgery aptitude. Similar improvements are seen for exercise domains shared between MdVT and dVSS groups. Follow-up studies are necessary to assess the efficacy of MdVT over a wider spectrum of domains.
Available from: HWR Schreuder
- "Moreover, training on the dVT can actually improve performance on the robot system equal to training with the robot itself. Improvement of technical surgical performance can be achieved within a relatively short period of time [20, 21]. Another important question is if this VR system could also be used for assessment of robotic skills . "
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With the increase in robotic-assisted laparoscopic surgery there is a concomitant rising demand for training methods. The objective was to establish face and construct validity of a novel virtual reality simulator (dV-Trainer, Mimic Technologies, Seattle, WA) for the use in training of robot-assisted surgery.
A comparative cohort study was performed. Participants (n = 42) were divided into three groups according to their robotic experience. To determine construct validity, participants performed three different exercises twice. Performance parameters were measured. To determine face validity, participants filled in a questionnaire after completion of the exercises.
Experts outperformed novices in most of the measured parameters. The most discriminative parameters were "time to complete" and "economy of motion" (P < 0.001). The training capacity of the simulator was rated 4.6 ± 0.5 SD on a 5-point Likert scale. The realism of the simulator in general, visual graphics, movements of instruments, interaction with objects, and the depth perception were all rated as being realistic. The simulator is considered to be a very useful training tool for residents and medical specialist starting with robotic surgery.
Face and construct validity for the dV-Trainer could be established. The virtual reality simulator is a useful tool for training robotic surgery.
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ABSTRACT: Despite the increased dexterity and precision of robotic surgery, like any new surgical technology it is still associated with a learning curve that can impact patient outcomes. The use of surgical simulators outside of the operating room, in a low-stakes environment, has been shown to shorten such learning curves. We present a multidisciplinary validation study of a robotic surgery simulator, the da Vinci® Skills Simulator (dVSS). Trainees and attending faculty from the University of Toronto, Departments of Surgery and Obstetrics and Gynecology (ObGyn), were recruited to participate in this validation study. All participants completed seven different exercises on the dVSS (Camera Targeting 1, Peg Board 1, Peg Board 2, Ring Walk 2, Match Board 1, Thread the Rings, Suture Sponge 1) and, using the da Vinci S Robot (dVR), completed two standardized skill tasks (Ring Transfer, Needle Passing). Participants were categorized as novice robotic surgeon (NRS) and experienced robotic surgeon (ERS) based on the number of robotic cases performed. Statistical analysis was conducted using independent T test and non-parametric Spearman's correlation. A total of 53 participants were included in the study: 27 urology, 13 ObGyn, and 13 thoracic surgery (Table 1). Most participants (89 %) either had no prior console experience or had performed <10 robotic cases, while one (2 %) had performed 10-20 cases and five (9 %) had performed ≥20 robotic surgeries. The dVSS demonstrated excellent face and content validity and 97 and 86 % of participants agreed that it was useful for residency training and post-graduate training, respectively. The dVSS also demonstrated construct validity, with NRS performing significantly worse than ERS on most exercises with respect to overall score, time to completion, economy of motion, and errors (Table 2). Excellent concurrent validity was also demonstrated as dVSS scores for most exercises correlated with performance of the two standardized skill tasks using the dVR (Table 3). This multidisciplinary validation study of the dVSS provides excellent face, content, construct, and concurrent validity evidence, which supports its integrated use in a comprehensive robotic surgery training program, both as an educational tool and potentially as an assessment device.
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Virtual reality simulators with self-assessment software may assist novice robotic surgeons to augment direct proctoring in robotic surgical skill acquisition. We compare and correlate the da Vinci Trainer™ (dVT) and da Vinci Surgical Skills Simulators (dVSSS) in subjects with varying robotic experience.
Materials and methods:
Students, urology residents, fellows, and practicing urologists with varying robotic experience were enrolled after local institutional review board approval. Three virtual reality tasks were preformed in sequential order (pegboard 1, pegboard 2, and tubes)-initially on the dVSSS and then on the dVT. The Mimic™ software used on both systems provides raw values and percent scores that were used in statistical evaluation. Statistical analysis was performed with the two-tailed independent t-test, analysis of variance, Tukey, and the Pearson rank correlation coefficient where appropriate.
Thirty-two participants were recruited for this study and separated into five groups based on robotic surgery experience. In regards to construct validity, both simulators were able to differentiate differences among the five robotic surgery experience groups in the tubes suturing task (p≤0.00). Sixty-seven percent (4/6) robotic experts thought that surgical simulation should be implemented in residency training. The overall cohort considered both platforms easy to learn and use.
Although performance scores were less in the dVT compared with the dVSSS, both simulators demonstrate good content and construct validity. The simulators appear to be equivalent for assessing surgeon proficiency and either can be used for robotic skills training with self-assessment feedback.
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