Abstract
Background
Exponential development of minimally invasive techniques, such as robotic-assisted devices, raises the question of how to assess robotic surgery skills. Early development of virtual simulators has provided efficient tools for laparoscopic skills certification based on objective scoring, high availability, and lower cost. However, similar evaluation is lacking for robotic training. The purpose of this study was to assess several criteria, such as reliability, face, content, construct, and concurrent validity of a new virtual robotic surgery simulator.
Methods
This prospective study was conducted from December 2009 to April 2010 using three simulators dV-Trainers® (MIMIC Technologies®) and one Da Vinci S® (Intuitive Surgical®). Seventy-five subjects, divided into five groups according to their initial surgical training, were evaluated based on five representative exercises of robotic specific skills: 3D perception, clutching, visual force feedback, EndoWrist® manipulation, and camera control. Analysis was extracted from (1) questionnaires (realism and interest), (2) automatically generated data from simulators, and (3) subjective scoring by two experts of depersonalized videos of similar exercises with robot.
Results
Face and content validity were generally considered high (77 %). Five levels of ability were clearly identified by the simulator (ANOVA; p = 0.0024). There was a strong correlation between automatic data from dV-Trainer and subjective evaluation with robot (r = 0.822). Reliability of scoring was high (r = 0.851). The most relevant criteria were time and economy of motion. The most relevant exercises were Pick and Place and Ring and Rail.
Conclusions
The dV-Trainer® simulator proves to be a valid tool to assess basic skills of robotic surgery.
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References
Amodeo A, Linares Quevedo A, Joseph JV, Belgrano E, Patel HRH (2009) Robotic laparoscopic surgery: cost and training. Minerva Urol Nefrol 61(2):121–128
Callery MP, Strasberg SM, Soper NJ (1996) Complications of laparoscopic general surgery. Gastrointest Endosc Clin N Am 6(2):423–444
Bruynzeel H, de Bruin AF, Bonjer HJ, Lange JF, Hop WC, Ayodeji ID, Kazemier G (2007) Desktop simulator: key to universal training? Surg Endosc 21(9):1637–1640
Van Dongen KW, Tournoij E, van der Zee DC, Schijven MP, Broeders IA (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21(8):1413–1417
Kroeze SGC, Mayer EK, Chopra S, Aggarwal R, Darzi A, Patel A (2009) Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 56(5):865–873
Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12(2):210–212
Xeroulis G, Dubrowski A, Leslie K (2009) Simulation in laparoscopic surgery: a concurrent validity study for FLS. Surg Endosc 23(1):161–165
Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM (2010) Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. Am J Surg 199(1):115–120
Feldman LS, Sherman V, Fried GM (2004) Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 135(1):28–42
Sweet RM, Hananel D, Lawrenz F (2010) A unified approach to validation, reliability, and education study design for surgical technical skills training. Arch Surg 145(2):197–201
Van Nortwick SS, Lendvay TS, Jensen AR, Wright AS, Horvath KD, Kim S (2010) Methodologies for establishing validity in surgical simulation studies. Surgery 147(5):622–630
Chipman JG, Schmitz CC (2009) Using objective structured assessment of technical skills to evaluate a basic skills simulation curriculum for first-year surgical residents. J Am Coll Surg 209(3):364–370
Hogle NJ, Briggs WM, Fowler DL (2007) Documenting a learning curve and test-retest reliability of two tasks on a virtual reality training simulator in laparoscopic surgery. J Surg Educ 64(6):424–430
Gallagher AG, Ritter EM, Satava RM (2003) Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17(10):1525–1529
Kenney PA, Wszolek MF, Gould JJ, Libertino JA, Moinzadeh A (2009) Face, content, and construct validity of dV-Trainer: a novel virtual reality simulator for robotic surgery. Urology 73(6):1288–1292
Sethi AS, Peine WJ, Mohammadi Y, Sundaram CP (2009) Validation of a novel virtual reality robotic simulator. J Endourol 23(3):503–508
Lendvay TS, Casale P, Sweet R, Peters C (2008) VR robotic surgery: randomized blinded study of the dV-Trainer robotic simulator. Stud Health Technol Inform 132:242–244
Lerner MA, Ayalew M, Peine WJ, Sundaram CP (2010) Does training on a virtual reality robotic simulator improve performance on the da Vinci surgical system? J Endourol 24(3):467–472
Hogle NJ, Chang L, Strong VEM, Welcome AOU, Sinaan M, Bailey R, Fowler DL (2009) Validation of laparoscopic surgical skills training outside the operating room: a long road. Surg Endosc 23(7):1476–1482
Grover S, Tan GY, Srivastava A, Leung RA, Tewari AK (2010) Residency training program paradigms for teaching robotic surgical skills to urology residents. Curr Urol Rep 1(2):87–92
Seixas-Mikelus SA, Stegemann AP, Kesavadas T, Srimathveeravalli G, Sathyaseelan G, Chandrasekhar R, Wilding GE, Peabody JO, Guru KA (2011) Content validation of a novel robotic robotic surgical simulator. BJU Int 107(7):1130–1135
Seixas-Mikelus SA, Kesavadas T, Srimathveeravalli G, Chandrasekhar R, Wilding GE, Guru KA (2010) Face Validation of a novel surgical simulator. Urology 76(2):357–360
Hung AJ, Zehnder P, Patil MB, Cai J, Ng CK, Aron M, Gill IS, Desai MM (2011) Face, content and construct validity of a novel robotic surgery simulator. J Urol 186(3):1019–1025
Gallagher AG, Ritter EM, Satava RM (2003) Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17(10):1525–1529
Acknowledgments
The authors thank Ecole de Chirurgie de Nancy and its staff, CRAN (Centre de Recherche en Automatisme de Nancy) and its staff, Conseil Régional de Lorraine, Communauté Urbaine du Grand Nancy, and Association des Chefs de Service du CHU de Nancy. This work was supported by Conseil Régional de Lorraine, Communauté Urbaine du Grand Nancy, and Association des Chefs de Service du CHU de Nancy.
Disclosures
Cyril Perrenot, Dr. Perez, Dr. Tran, Jehl Jean-Philippe, Dr. Felblinger, Dr. Bresler, and Dr. Hubert have no conflict of interest or financial ties to disclose.
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Perrenot, C., Perez, M., Tran, N. et al. The virtual reality simulator dV-Trainer® is a valid assessment tool for robotic surgical skills. Surg Endosc 26, 2587–2593 (2012). https://doi.org/10.1007/s00464-012-2237-0
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DOI: https://doi.org/10.1007/s00464-012-2237-0