Transferability of Virtual Reality, Simulation-Based, Robotic Suturing Skills to a Live Porcine Model in Novice Surgeons: A Single-Blind Randomized Controlled Trial.

STUDY OBJECTIVE: To assess whether a robotic simulation curriculum for novice surgeons can improve performance of a suturing task in a live porcine model.

DESIGN: Randomized controlled trial (Canadian Task Force classification I).

SETTING: Academic medical center.

PATIENTS: Thirty-five medical students without robotic surgical experience.

INTERVENTIONS: Participants were enrolled in an online session of training modules followed by an in-person orientation. Baseline performance testing on the Mimic Technologies da Vinci Surgical Simulator (dVSS) was also performed. Participants were then randomly assigned to the completion of 4 dVSS training tasks (camera clutching 1, suture sponge 1 and 2, and tubes) versus no further training. The intervention group performed each dVSS task until proficiency or up to 10 times. A final suturing task was performed on a live porcine model, which was video recorded and blindly assessed by experienced surgeons. The primary outcomes were Global Evaluative Assessment of Robotic Skills (GEARS) scores and task time. The study had 90% power to detect a mean difference of 3 points on the GEARS scale, assuming a standard deviation (SD) of 2.65, and 80% power to detect a mean difference of 3 minutes, assuming an SD of 3 minutes.

MEASUREMENTS AND MAIN RESULTS: There were no differences in demographics and baseline skills between the 2 groups. No significant differences in task time in minutes or GEARS scores were seen for the final suturing task between the intervention and control groups, respectively (9.2 [2.65] vs 9.9 [2.07] minutes, p = .406; and 15.37 [2.51] vs 15.25 [3.38], p = .603). The 95% confidence interval for the difference in mean task times was -2.36 to .96 minutes and for mean GEARS scores -1.91 to 2.15 points.

CONCLUSIONS: Live suturing task performance was not improved with a proficiency-based virtual reality simulation suturing curriculum compared with standard orientation to the da Vinci robotic console in a group of novice surgeons.