Robotic Surgery: The Impact of Simulation and Other Innovative Platforms on Performance and Training

Abstract

To review the current status of robotic training and the impact of various training platforms on the performance of robotic surgical trainees. Data Sources: Literature review of Google Scholar and PubMed. The search terms included a combination of the following: "robotic training," "simulation," "robotic curriculum," "obgyn residency robotic training," "virtual reality robotic training," "DaVinci training," "surgical simulation," "gyn surgical training." The sources considered for inclusion included peerreviewed articles, literature reviews, textbook chapters, and statements from various institutions involved in resident training. Methods of Study Selection: A literature search of Google Scholar and PubMed using terms related to robotic surgery and robotics training, as mentioned in the "Data Sources" section. Results: Multiple novel platforms that use machine learning and real-time video feedback to teach and evaluate robotic surgical skills have been developed over recent years. Various training curricula, virtual reality simulators, and other robotic training tools have been shown to enhance robotic surgical education and improve surgical skills. The integration of didactic learning, simulation, and intraoperative teaching into more comprehensive training curricula shows positive effects on robotic skills proficiency. Few robotic surgery training curricula have been validated through peer-reviewed study, and there is more work to be completed in this area. In addition, there is a lack of information about how the skills obtained through robotics curricula and simulation translate into operating room performance and patient outcomes. Conclusion: Data collected to date show promising advances in the training of robotic surgeons. A diverse array of curricula for training robotic surgeons continue to emerge, and existing teaching modalities are evolving to keep up with the rapidly growing demand for proficient robotic surgeons. Futures areas of growth include establishing competency benchmarks for existing training tools, validating existing curricula, and determining how to translate the acquired skills in simulation into performance in the operating room and patient outcomes. Many surgical training platforms are beginning to expand beyond discrete robotic skills training to procedure-specific and team training. There is still a wealth of research to be done to understand how to create an effective training experience for gynecologic surgical trainees and robotics teams.

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education

“…Virtual reality simulation involves the manipulation of computer-simulated instruments in an artificial world [ 21 ]. Virtual reality simulators can train a wide range of psychomotor skills through discrete tasks, procedural training and team training [ 5 ]. Basic robotic skills, dissection, retraction, cutting and suturing can be learned on virtual reality simulators [ 22 ].…”

“…Due to the heterogeneity of the curricula included in the validation studies for virtual reality simulation, it is difficult to identify specific virtual exercises result in skill transfer into the operating room. Despite this, virtual reality simulation has been established as a valid training tool for robotic surgery [ 5 ]. Level 2 and 3 evidence for face, content and construct validity of VR simulation has been reported for the six major commercial simulation machines available for robot-assisted surgery [ 4 , 23 , 24 ].…”

“…The current training pathway recommended by Intuitive for the da Vinci system includes a brief online course of 3 h, a dry laboratory session, virtual reality simulation if available, and then two pig procedures followed by two proctored live surgeries [ 3 ]. The validity of this credentialling pathway is not standardised and needs review to assess its adequacy to deliver robotic surgery competency [ 4 , 5 ]. In fact, robotic surgery was considered as one of the top ten health technology hazards in 2015 [ 5 ].…”

“…The validity of this credentialling pathway is not standardised and needs review to assess its adequacy to deliver robotic surgery competency [ 4 , 5 ]. In fact, robotic surgery was considered as one of the top ten health technology hazards in 2015 [ 5 ]. Considering the long learning curves reported to require 300 cases for robotic prostatectomy and 50 to 100 cases for robotic gynaecological procedures, Intuitive’s current recommended pathway appears inadequate [ 6 – 11 ].…”

Perspective of robotic surgery in Colombia, are we doing well?

“…It has been implemented in different areas, including medicine, specifically in the surgical field; robotic surgery is nothing more than a procedure performed through a computer, which an experienced surgeon directs. It is currently considered the future of surgery worldwide due to its significant impacts and the multiple advances presented in the last decades [2,3] .…”