title: Evaluation of robotic cardiac surgery simulation training: A randomized controlled trial.
abstract: OBJECTIVE
  To compare the currently available simulation training modalities used to teach robotic surgery.
  
  
  METHODS
  Forty surgical trainees completed a standardized robotic 10-cm dissection of the internal thoracic artery and placed 3 sutures of a mitral valve annuloplasty in porcine models and were then randomized to a wet lab, a dry lab, a virtual reality lab, or a control group that received no additional training. All groups trained to a level of proficiency determined by 2 expert robotic cardiac surgeons. All assessments were evaluated using the Global Evaluative Assessment of Robotic Skills in a blinded fashion.
  
  
  RESULTS
  Wet lab trainees showed the greatest improvement in time-based scoring and the objective scoring tool compared with the experts (mean, 24.9 ± 1.7 vs 24.9 ± 2.6; P = .704). The virtual reality lab improved their scores and met the level of proficiency set by our experts for all primary outcomes (mean, 24.9 ± 1.7 vs 22.8 ± 3.7; P = .103). Only the control group trainees were not able to meet the expert level of proficiency for both time-based scores and the objective scoring tool (mean, 24.9 ± 1.7 vs 11.0 ± 4.5; P < .001). The average duration of training was shortest for the dry lab and longest for the virtual reality simulation (1.6 hours vs 9.3 hours; P < .001).
  
  
  CONCLUSIONS
  We have completed the first randomized controlled trial to objectively compare the different training modalities of robotic surgery. Our data demonstrate the significant benefits of wet lab and virtual reality robotic simulation training and highlight key differences in current training methods. This study can help guide training programs in investing resources in cost-effective, high-yield simulation exercises.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada. Electronic address: matthew.valdis@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Valdis
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Division of General Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schlachta
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence; D004210:Dissection / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000191:economics*; D009864:Ontario; D065287:Robotic Surgical Procedures / Q000193:education*; D000066908:Simulation Training / Q000379:methods*; D013536:Suture Techniques / Q000193:education*; D013552:Swine; D013903:Thoracic Surgery / Q000193:education* / Q000379:methods; D014584:User-Computer Interface
keywords: dry lab; randomized controlled trial; robotic cardiac surgery; simulation training; virtual reality; wet lab