title: Conventional Laparoscopic vs Robotic Training: Which is Better for Naive Users? A Randomized Prospective Crossover Study.
abstract: OBJECTIVE
  Robotic training (RT) using the da Vinci skills simulator and conventional training (CT) using a laparoscopic "training box" are both used to augment operative skills in minimally invasive surgery. The current study tests the hypothesis that skill acquisition is more rapid using RT than using CT among naive learners.
  
  
  METHODS
  A total of 40 subjects without laparoscopic or robotic surgical experience were enrolled and randomized to begin with either RT or CT. Then, 2 specific RT tasks were reproduced for CT and repeated 5 times each with RT and CT. Time and quality indicators were measured quantitatively. A crossover technique was used to control for in-study experience bias.
  
  
  RESULTS
  The tasks "pick and place jacks" (PP) and "thread the rings" (TR) were achieved faster with RT than with CT despite crossover (p < 0.0001). An RT-favoring difference was observed in speed for both tasks when changing modality. Percentage improvement with increasing trials was similar for RT and CT: RT completion time averaged 39 seconds and 211 seconds (PP and TR, respectively), compared with 65 seconds and 362 seconds when using CT (p < 0.0001); final improvement averaged 26% and 46% for RT (PP and TR, respectively) vs 31% and 47% for CT (p was 0.76 for PP and 0.20 for TR). Within the PP task, RT times averaged 41 seconds without previous CT experience vs 35 seconds with previous CT experience (p = 0.20); CT times averaged 61 seconds without and 69 seconds with previous RT experience (p = 0.48). Comparable times for the TR task were 212 seconds vs 216 seconds (p = 0.66) and 388 seconds vs 334 seconds (p = 0.17). Both instrument collisions and excessive force occurred more commonly for RT than for CT within the TR task (p < 0.0001).
  
  
  CONCLUSIONS
  Speeds were faster overall with RT than with CT, but the percentage of speed improvement with trials was similar, suggesting similar learning curves, with minimal transfer effect appreciated.
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors: Syed Omar
authors: SO
authors: Hassan
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors: Jaimin
authors: J
authors: Dudhia
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors: Labiq H
authors: LH
authors: Syed
authors: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Kalpesh
authors: K
authors: Patel
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors: Maham
authors: M
authors: Farshidpour
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors: Steven C
authors: SC
authors: Cunningham
authors: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland. Electronic address: gkowdley@stagnes.org.
authors: Gopal C
authors: GC
authors: Kowdley
mesh_terms: D002983:Clinical Competence; D018592:Cross-Over Studies; D003479:Curriculum; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D011446:Prospective Studies; D012371:Robotics / Q000193:education*; D000066908:Simulation Training
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; conventional laparoscopy; efficient; learning curve; naive; robotic training; transfer effect