Fundamental skills of robotic surgery: A multi-institutional randomized controlled trial for validation of a simulation-based curriculum

Objective: To develop and establish effectiveness of simulation-based robotic curriculum - fundamental skills of robotic surgery (FSRS). Methods: FSRS curriculum was developed and incorporated into a virtual reality simulator, Robotic Surgical Simulator (RoSS). Fifty-three participants were randomized into an experimental group (EG) or control group (CG). The EG was asked to complete the FSRS and 1 final test on the da Vinci Surgical System (dVSS). The dVSS test consisted of 3 tasks: ball placement, suture pass, and fourth arm manipulation. The CG was directly tested on the dVSS then offered the chance to complete the FSRS and re-tested on the dVSS as a crossover (CO) group. Results: Sixty-five percent of participants had never formally trained using laparoscopic surgery. Ball placement: the EG demonstrated shorter time (142 vs 164 seconds, P =.134) and more precise (1.5 vs 2.5 drops, P =.014). The CO took less time (P <.001) with greater precision (P <.001). Instruments were rarely lost from the field. Suture pass: the EG demonstrated better camera utilization (4.3 vs 3.0, P =.078). Less instrument loss occurred (0.5 vs 1.1, P =.026). Proper camera usage significantly improved (P =.009). Fourth arm manipulation: the EG took less time (132 vs 157 seconds, P =.302). Meanwhile, loss of instruments was less frequent (0.2 vs 0.8, P =.076). Precision in the CO improved significantly (P =.042) and camera control and safe instrument manipulation showed improvement (1.5 vs 3.5, 0.2 vs 0.9, respectively). Conclusion: FSRS curriculum is a valid, feasible, and structured curriculum that demonstrates its effectiveness by significant improvements in basic robotic surgery skills.