Acceptability of a Robotic Hysterectomy Simulation System - Who Is the Target Audience?

Abstract

Study Objective To assess acceptability of the Simbionix (3D) Hysterectomy Modules for the DaVinci Xi simulation system. These simulation modules became available in 2017. Little validation evidence exists to guide incorporation of this tool into surgical education. Design Prospective cohort. Setting Multi-center, academic medical institutions. Patients or Participants Residents, fellows, and faculty in Obstetrics and Gynecology were invited to participate at 3 institutions. Participants were categorized by experience level: less than 10 hysterectomies (novice), 10 to 49 hysterectomies (intermediate), and 50 or greater hysterectomies (expert). A total of 10 novice, 9 intermediate, and 15 expert surgeons were included. Interventions Participants completed 4 simulator modules (ureter identification, bladder flap development, colpotomy, and complete hysterectomy) and a qualitative survey assessing agreement or disagreement with evaluative statements using a Likert scale. Measurements and Main Results The majority felt the simulator realistically simulated robotic hysterectomy (64.7%) and that it should be used to provide feedback to residents (67.6%). The majority thought the feedback provided by the simulator was as or more helpful than feedback from previous surgical simulations (88.2%) but less helpful than feedback provided in the operating room (73.5%). The majority agreed that residents should be required to pass modules prior to completing a robotic hysterectomy as a primary surgeon (52.9%), but disagreed that they should be used for licensing purposes (58.8%). There were no significant differences in opinion between experience levels (p-value >0.05 for all questions using Fisher's exact test). Participants felt this simulator would be helpful for teaching general steps to junior residents. Conclusion Simbionix (3D) Hysterectomy Modules were well received by subjects of all experience levels. Subjects identified early residency education as an area where this tool can be used to provide feedback and determine readiness to perform robotic hysterectomy. Feedback from the simulator was not felt to replace real-time, clinical feedback. Further study is needed to determine its role in surgical training.