Comparison of Robotic Surgery Skill Acquisition Between Dv-trainer and Da Vinci Surgical System: A Randomized Controlled Study
Ruslan Korets, Adam C. Mues, Joseph A. Graversen, Mantu Gupta, Jaime Landman, Ketan K. Badani
Introduction and Objective
Currently, no standardized curriculum exists for robotic surgical education. Training courses using the da Vinci® surgical system (dVSS) on inanimate or, less commonly, animal models are limited and expensive, further diminishing the training opportunities for naïve surgeons to develop their skills before attempting live cases. The Mimic dV-Trainer (MdVT) is a compact hardware platform that closely reproduces the experience of the dVSS console. The primary objective was to compare robotic surgery skill acquisition of resident trainees using MdVT and dVSS.
Sixteen urology trainees were randomized into three groups. A baseline evaluation using dVSS was performed consisting of two exercises requiring endowrist manipulation (EM), camera movement (CM), needle control (NC), and robotic suturing (RS) as well as completion of a self-assessment questionnaire. Group 1 and 2 completed a standardized training curriculum on MdVT and dVSS, respectively, while Group 3 received no additional training. The MdVT curriculum was designed to train subjects in EM and CM, while the dVSS training set consisted of all exercises evaluated during baseline evaluation. After completion of the training phase, all trainees completed a secondary evaluation on dVSS consisting of same exercises performed during baseline evaluation. Performance was evaluated using Objective Structured Assessments of Technical Skill technique.
The three groups were well balanced with regard to urology training level and prior robotic surgery experience. There was no difference in baseline performance scores across the 3 groups. While the control group showed no significant improvement in EM/CM domain (p=0.15), Group 1 and 2 had statistically significant improvement in EM/CM domain p=0.039 and p=0.007, respectively. The difference in improvement between Group 1 and Group 2 was not statistically different (p=0.21). Only the trainees trained in the NC and RS (Group 2), showed significant improvement in that domain during secondary evaluation (p=0.02).
Curriculum-based training with either MdVT or dVSS significantly improved robotic surgery aptitude when compared to no training. Furthermore, there was no difference in improvement during secondary evaluation for the exercises shared between MdVT and dVSS groups, suggesting that MdVT is equivalent to dVSS for improving robotic aptitude in EM and CM. Follow-up studies are necessary to assess the efficacy of MdVT over a wider spectrum of domains.