Operative performance outcomes of a simulator-based robotic surgical skills curriculum

Background: Robotic technology has become increasingly prevalent throughout modern surgical practice as surgical training programs are determining how to best include this robotic training in their curricula. In this study, we sought to measure changes in performance and workload metrics in the live operative setting following completion of a novel simulator-based robotic skills curriculum. Methods: 31 surgical residents naïve to robotic platforms were recruited. They first participated in a live robotic case and had a baseline assessment using RO-SCORE, a robotic modification of the O-SCORE tool, and self-assessed their workload using the NASA Task Load Index (NTLX). Subjects then completed the curriculum, created by an expert panel, on a da Vinci Skills Simulator to pre-set proficiency goals. Subjects were encouraged to train on their own time and could complete the curriculum in one or more sittings, in a 1-month time period. Subjects were then assessed after another live case. Data were analyzed using paired Student’s t test. Results: Completion of the curriculum was associated with significant RO-SCORE improvements in operative performance across all domains including Camera Control (pre-curriculum mean: 1.9; post-curriculum mean: 4.8; p ' 0.001), Needle Control (pre-curriculum mean: 1.7; post-curriculum mean: 4.4; p ' 0.001), Tissue Handling (pre-curriculum mean: 2.0; post-curriculum mean: 4.4; p ' 0.001). There were significant reductions in all NTLX workload domains including Physical Demand (pre-curriculum mean: 5.2; post-curriculum mean: 2.1; p ' 0.001), and Frustration (pre-curriculum mean: 6.4; post-curriculum mean: 1.42; p ' 0.001). Conclusions: We describe a feasible robotic simulation curriculum that requires a reasonable amount of time and is self-directed. Significant improvements were seen across all performance metrics and subjective operator workload. Importantly, this is translated to the clinical environment. These types of curricula will be necessary for improving the skills and confidence of trainees and attending surgeons as robotic technology becomes more pervasive.