Evaluation of robotic cardiac surgery simulation training: A randomized controlled trial

Abstract

We have completed the first randomized controlled trial to objectively compare the different training modalities of robotic surgery. Our data demonstrate the significant benefits of wet lab and virtual reality robotic simulation training and highlight key differences in current training methods. This study can help guide training programs in investing resources in cost-effective, high-yield simulation exercises.

The Evolution of Robotic Surgical Training: A Short Communication on the Evaluation of Robotic Cardiac Surgery Simulation Training: A Randomized Controlled Trial

“…By far and away the individuals in the wet lab outperformed all other training methods. These individuals proved to be able to complete both tasks significantly faster than all other groups and even faster than our experts [3]. The scoring tool that was used to assess intraoperative performance was unable to detect any difference between the performance of these individuals and that of our experts indicating that they had reached the expert's level of proficiency [3].…”

“…This learning curve unfortunately can be a difficult and anxiety provoking period for the institution, patient and surgeon, and can be fraught with higher rates of complications and adverse events. This is even more significant in robotics, as the high upfront investment of significant resources and increased operating costs, create little room for anything but exceptional clinical results and patient outcomes, as patients and institutions demand a return on their investments [3]. This fact may be, by far, the greatest barrier as to why robotics has failed to become more mainstream in cardiac surgery.…”

“…Certainly a training institution investing significant resources in the education of their trainees should have more significant evidence to rely on before they embark on initiating a program such as these. From here we set out to complete one of the largest studies of its kind and the first ever prospective RCT comparing the major simulation platforms currently used in surgical training with an untrained control [3].…”

“…Each of these simulation platforms was carefully designed with the input from multiple expert robotic surgeons in order to focus on the most important and universal robotic skills necessary to operate the robot successfully. The actual protocols can be found published elsewhere [3,8]. Once the training in each stream was completed, and trainees were able to meet the levels of proficiency set by our expert surgeons, they were brought back to repeat the initial assessment which again was recorded, deidentified and scored to look for improvements with training and to compare performances between the different groups.…”

“…We must therefore seek out new strategies for developing innovative training techniques in safe environments in order to allow for the specialty to evolve and to improve care, safety and costs to society. This is where our group began when we set out to develop a standardized training program at our institution for trainees attempting to gain experience with robotic cardiac surgery [3]. Trainees coming to our center for robotic training have a limited number of cases that they will be exposed to during their training.…”