ROSIM Presentation: Virtual Reality- vs Dry Lab Robotic Surgery Training

Virtual Reality and Dry Lab Robotic Hepaticojejunostomy Suturing Training in Novices (ROSIM): randomized experimental crossover trial

Julia E. Menso1,2, A. Masie Rahimi2,3, Maurice J.W. Zwart1,2, Joey de Hondt1,2, Roberto M. Montorsi1,2,4, Freek Daams2,3, Marc G. Besselink1,2
1 Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands;
2 Cancer Center Amsterdam, the Netherlands
3 Amsterdam UMC, location Vrije Universiteit, Department of Surgery, the Netherlands;
4 Department of Surgery, Verona University Hospital, University of Verona, Italy.

Background: Robotic suturing training for novices is often done in artificial organ models with subjective assessment of performance. Performance has not yet been examined with advanced tasks in biotissue nor objectively assessed with force measurements. The effect of the da Vinci SimNow simulator on robotic suturing in this setting is unclear.

Methods: Randomized experimental cross-over trial including 20 robotic novices from 3 countries who practiced robotic suturing with the SimNow (VR) and suture pad (dry-lab). Participants were randomized to start either with VR (intervention group, n=10) or dry-lab (control group, n=10) and thereafter crossed-over. All participants completed two robotic suturing exams with a hepaticojejunostomy in biotissue; both after VR and dry-lab training. Primary endpoint was the objective structured assessment of technical skill (OSATS) score, anonymously scored by two raters. Secondary endpoints were force measurements (including maximum force and maximum impulse), and procedure time. Also, a qualitative analysis of the SimNow was performed using a questionnaire.

Results: Overall, 20 robotic novices completed the robotic suturing training and 40 robotic hepaticojejunostomies. The mean combined OSATS was similar between groups in the first exam (2.4±0.8 vs 2.4±0.7; p=0.791) and higher in the intervention (VR first) group in the second exam (3.3±0.9 vs 2.5±0.8, respectively; p=0.049). The median maximum force (N) on tissue was similar between groups in the first exam (5.6(3.0-7.1) vs 4.7(2.9-8.1); p=0.912) and second exam (5.0(3.2-8.0) vs 3.8(2.3-12.8); p=0.739). The median maximum impulse (Ns) was similar between groups in the first exam (11.2(7.3-56.2) vs 21.0(10.8-52.0); p=0.353) and second exam (15.4 7.7-19.5) vs 11.7(8.8-40.5); p=0.971). Procedure time was similar between groups for the first exam (15.0±0.00 vs 15.0±0.00; p=0.123) and second exam (14.9±0.2 vs 13.8±3.6; p=0.739). In the questionnaire, 17/20 (85%) participants recommended to include VR training with the SimNow and 20/20 (100%) to include dry-lab training. Overall, 14/20 (70%) participants preferred to start with VR. VR training is more accessible with lower costs and less set-up time compared to dry-lab training.

Conclusion: Surgical performance of robotic novices was similar after single training with VR versus dry-lab. Sequentially, a robotic suturing curriculum including both VR and dry-lab should ideally start with VR.