title: Structured training on the da Vinci Skills Simulator leads to improvement in technical performance of robotic novices.
abstract: BACKGROUND
  The increasing use of minimally invasive techniques such as robotic-assisted devices raises the question of how to acquire robotic surgery skills. The da Vinci Skills Simulator has been demonstrated to be an effective training tool in previous reports. To date, little data are available on how to acquire proficiency through simulator training. We investigated the outcome of a structured training programme for robotic surgical skills by robotic novices.
  
  
  METHODS
  This prospective study was conducted from January to December 2013 using the da Vinci Skills Simulator. Twenty participants, all robotic novices, were enrolled in a 4-week training curriculum. After a brief introduction to the simulator system, three consecutive repetitions of five selected exercises (Match Board 1, 2, 3 and Ring and Rail 1, 2) were performed in a defined order on days 1, 8, 15 and 22. On day 22, one repetition of a previously unpractised more advanced module (Needle Targeting) was also performed. After completion of each study day, the overall performance, time to completion, economy in motion, instrument collisions, excessive instrument force, instruments out of view, master workspace range and number of drops were analysed.
  
  
  RESULTS
  Comparing the first and final repetition, overall score and time needed to complete all exercises, economy of motion and instrument collisions were significantly improved in nearly all exercises. Regarding the new exercise, a positive training effect could be demonstrated. While its overall entry score was significantly higher, the time to completion and economy of motion were significantly lower than the scores on the first repetition of the previous 5 exercises.
  
  
  CONCLUSIONS
  It could be shown that training on the da Vinci Skills Simulator led to an improvement in technical performance of robotic novices. With regard to a new exercise, the training had a positive effect on the technical performance.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Walliczek-Dworschak
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mandapathil
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Förtsch
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Teymoortash
authors.affiliation: Center of Orthopedics and Traumatology, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dworschak
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: J A
authors.initials: JA
authors.lastname: Werner
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Giessen and Marburg, Marburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Güldner
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D005260:Female; D006801:Humans; D008297:Male; D011214:Practice, Psychological; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000193:education*; D000066908:Simulation Training; D055815:Young Adult