Validation of a Simulation Model for Robotic Myomectomy

Abstract

Study ObjectiveSeveral simulation models have been evaluated for gynecologic procedures such as hysterectomy, but there are limited published data for myomectomy. This study aimed to assess the validity of a low-cost robotic myomectomy model for surgical simulation training. DesignProspective cohort simulation study. SettingSurgical simulation lab. ParticipantsTwelve obstetrics and gynecology residents and four fellowship-trained minimally invasive gynecologic surgeons were recruited for a 3:1 novice-to-expert ratio. InterventionsA robotic myomectomy simulation model was constructed using <$5 worth of materials: a foam cylinder, felt, a stress ball, bandage wrap, and multipurpose sealing wrap. Participants performed a simulation task involving two steps: fibroid enucleation and hysterotomy repair. Video recorded performances were timed and scored by two blinded reviewers using the validated Global Evaluative Assessment of Robotic Skills (GEARS) scale (5-25 points) and a modified GEARS scale (5-40 points), which adds three novel domains specific to robotic myomectomy. Performance was also scored using predefined task errors. Participants completed a post-task questionnaire assessing the model's realism and utility. Measurements and Main ResultsMedian task completion time was shorter for experts compared to novices (9.7 vs. 24.6 minutes, P=.001). Experts scored higher than novices on both the GEARS scale (median 23 vs. 12, P=.004) and modified GEARS scale (36 vs. 20, P=.004). Experts made fewer task errors than novices (median 15.5 vs. 37.5, P=.034). For interrater reliability of scoring, the intraclass correlation coefficient was calculated to be 0.91 for the GEARS assessment, 0.93 for the modified GEARS assessment, and 0.60 for task errors. Using the contrasting groups method, the passing mark for the simulation task was set to a minimum modified GEARS score of 28 and a maximum of 28 errors. Most participants agreed that the model was realistic (62.5%) and useful for training (93.8%). ConclusionWe have demonstrated evidence supporting the validity of a low-cost robotic myomectomy model. This simulation model and the performance assessments developed in this study provide further educational tools for robotic myomectomy training.