1512 DEVELOPMENT, IMPLEMENTATION AND VALIDATION OF A SIMULATION-BASED CURRICULUM FOR ROBOT-ASSISTED SURGERY

Abstract

INTRODUCTION AND OBJECTIVES: Effective and validated instructions to assess and improve skills in robot-assisted (RA) surgery are needed. A simulation-based curriculum was implemented using the Robotic Surgical Simulator (RoSS). The RoSS curriculum consists of 15 tasks with progressive levels of difficulty and was developed after consensus with experienced robotic surgeons. We sought to implement and evaluate the RoSS curriculum. METHODS: 25 participants were randomized into either a Test Group (TG; n 13) or Control Group (CG; n 12) in an IRB-approved study. Trainees in the TG were asked to complete the RoSS curriculum and 1 test session on the daVinci Surgical System (dVSS). Average completion of the RoSS curriculum took 4 hours and was conducted over a 1-4 week period. Each session did not exceed 1 hour in duration. Trainees in the CG directly tested on dVSS and were offered the chance to complete the RoSS curriculum and re-test on dVSS as a Crossover analysis (CO; n 8). The dVSS test consisted of three tasks: Ball Placement, Suture Pass, and 4th Arm Manipulation. RESULTS: 75% of trainees were between 25-40 years and 75% had never been formally trained for laparoscopic surgery. Only 21% had ever worked on a surgical console. 66% of participants felt RoSS would help them prepare for surgical training. Ball Placement: TG demonstrated shorter completion time (124 vs. 164 sec; p 0.041) and was more precise during the task compared to CG (1.2 vs. 2.5 drops; p 0.018). The CO group took less time (p 0.07) to complete this task with significantly greater precision after finishing the curriculum (p 0.008). Instruments were never lost from the field after completing the curriculum. Suture Pass: TG group demonstrated better camera utilization (3.1 vs. 1.0; 0.035). Instruments loss from field of vision was significantly less for TG (0.6 vs. 1.6; 0.022) Precision trended towards significance (p 0.06) in CO group, while proper camera usage significantly improved after completion of RoSS curriculum (p 0.016). Fourth Arm Manipulation: TG took less time to complete (117 vs. 150 sec; p 0.175). Meanwhile, loss of instruments outside training field was less frequent in the TG (0.2 vs. 0.6: p 0.234). Precision in the CO group improved significantly after completing the curriculum (p 0.03), and camera control and safe instrument manipulation also showed improvement at completion (1 vs. 0.2; 0.4 vs. 0.9). CONCLUSIONS: Implementation of this first of its kind robotassisted curriculum demonstrates that simulation training can significantly develop and improve skills for safe acquisition of robot-assisted surgery.