title: Augmented-reality-based skills training for robot-assisted urethrovesical anastomosis: a multi-institutional randomised controlled trial.
abstract: OBJECTIVE
  To validate robot-assisted surgery skills acquisition using an augmented reality (AR)-based module for urethrovesical anastomosis (UVA).
  
  
  METHODS
  Participants at three institutions were randomised to a Hands-on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure-based training for UVA within the haptic-enabled AR-based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross-over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank-sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross-over group).
  
  
  RESULTS
  A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention.
  
  
  CONCLUSIONS
  Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA; State University of New York, Buffalo, NY, USA.
authors.forename: Ashirwad
authors.initials: A
authors.lastname: Chowriappa
authors.forename: Syed Johar
authors.initials: SJ
authors.lastname: Raza
authors.forename: Anees
authors.initials: A
authors.lastname: Fazili
authors.forename: Erinn
authors.initials: E
authors.lastname: Field
authors.forename: Chelsea
authors.initials: C
authors.lastname: Malito
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Eun
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ghazi
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Thenkurussi
authors.initials: T
authors.lastname: Kesavadas
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education* / Q000379:methods / Q000592:standards; D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods / Q000592:standards; D065287:Robotic Surgical Procedures / Q000193:education* / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D014521:Urethra / Q000601:surgery*
keywords: anastomosis; augmented reality; robot-assisted; robotic; skills training; urethrovesical anastomosis