title: Proficiency training on a virtual reality robotic surgical skills curriculum.
abstract: BACKGROUND
  The clinical application of robotic surgery is increasing. The skills necessary to perform robotic surgery are unique from those required in open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (Fundamentals of Laparoscopic Surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool for robotic surgery. Our research group previously developed and validated a robotic training curriculum in a virtual reality (VR) simulator. We hypothesized that novice robotic surgeons could achieve proficiency levels defined by more experienced robotic surgeons on the VR robotic curriculum, and that this would result in improved performance on the actual daVinci Surgical System™.
  
  
  METHODS
  25 medical students with no prior robotic surgery experience were recruited. Prior to VR training, subjects performed 2 FLS tasks 3 times each (Peg Transfer, Intracorporeal Knot Tying) using the daVinci Surgical System™ docked to a video trainer box. Task performance for the FLS tasks was scored objectively. Subjects then practiced on the VR simulator (daVinci Skills Simulator) until proficiency levels on all 5 tasks were achieved before completing a post-training assessment of the 2 FLS tasks on the daVinci Surgical System™ in the video trainer box.
  
  
  RESULTS
  All subjects to complete the study (1 dropped out) reached proficiency levels on all VR tasks in an average of 71 (± 21.7) attempts, accumulating 164.3 (± 55.7) minutes of console training time. There was a significant improvement in performance on the robotic FLS tasks following completion of the VR training curriculum.
  
  
  CONCLUSIONS
  Novice robotic surgeons are able to attain proficiency levels on a VR simulator. This leads to improved performance in the daVinci surgical platform on simulated tasks. Training to proficiency on a VR robotic surgery simulator is an efficient and viable method for acquiring robotic surgical skills.
authors.affiliation: Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Bric
authors.forename: Michael
authors.initials: M
authors.lastname: Connolly
authors.forename: Andrew
authors.initials: A
authors.lastname: Kastenmeier
authors.forename: Matthew
authors.initials: M
authors.lastname: Goldblatt
authors.forename: Jon C
authors.initials: JC
authors.lastname: Gould
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education; D017145:Models, Educational; D012371:Robotics / Q000193:education*; D013337:Students, Medical; D013647:Task Performance and Analysis; D014481:United States; D014584:User-Computer Interface