title: Robotic Surgery Simulator: Elements to Build a Training Program.
abstract: OBJECTIVE
  Face, content, and construct validity of robotic surgery simulators were confirmed in the literature by several studies, but elements to build a training program are still lacking. The aim of our study was to validate a progressive training program and to assess according to prior surgical experience the amount of training needed with a robotic simulator to complete the program.
  
  
  METHODS
  Exercises using the Da Vinci Skill Simulator were chosen to ensure progressive learning. A new exercise could only be started if a minimal score of 80% was achieved in the prior one. The number of repetitions to achieve an exercise was not limited. We devised a "performance index" by calculating the ratio of the sum of scores for each exercise over the number of repetitions needed to complete the exercise with at least an 80% score.
  
  
  METHODS
  The study took place at the François Baclesse Cancer Center. Participants all work at the primary care university Hospital located next to the cancer center.
  
  
  METHODS
  A total of 32 surgeons participated in the study- 2 experienced surgeons, 8 junior and 8 senior residents in surgery, 6 registrars, and 6 attending surgeons.
  
  
  RESULTS
  There was no difference between junior and senior residents, whereas the registrars had better results (p < 0.0001). The registrars performed less exercise repetitions compared to the junior or senior residents (p = 0.012). Attending surgeons performed significantly more repetitions than registrars (p = 0.024), but they performed fewer repetitions than junior or senior residents with no statistical difference (p = 0.09). The registrars had a performance index of 50, which is the best result among all novice groups. Attending surgeons were between senior and junior residents with an index at 33.85.
  
  
  CONCLUSIONS
  Choice of basic exercises to manipulate different elements of the robotic surgery console in a specific and progressive order enables rapid progress. The level of prior experience in laparoscopic surgery affects outcomes. More advanced laparoscopic expertise seems to slow down learning, surgeons having to "unlearn" to acquire a new technique.
authors.affiliation: Urology and Transplantation Department, CHU de Caen, Caen, France; Normandy University, Caen, France. Electronic address: xavtillou@gmail.com.
authors.forename: Xavier
authors.initials: X
authors.lastname: Tillou
authors.affiliation: Orthopedic and Hand Surgery Department, CHU de Caen, Caen, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Collon
authors.affiliation: François Baclesse Cancer Center, Caen, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Martin-Francois
authors.affiliation: Urology and Transplantation Department, CHU de Caen, Caen, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Doerfler
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D059032:Learning Curve; D008297:Male; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D000066908:Simulation Training / Q000379:methods*; D012984:Software; D014584:User-Computer Interface
keywords: Patient Care; Practice-Based Learning and Improvement; Professionalism; education; robotics; simulation; surgery