Top

BMC Surgery

Published in:

01-12-2020 | Research article

Assessment of validity evidence for the RobotiX robot assisted surgery simulator on advanced suturing tasks

Authors: Erik Leijte, Ivo de Blaauw, Camiel Rosman, Sanne M. B. I. Botden

Published in: BMC Surgery | Issue 1/2020

Abstract

Background

Robot assisted surgery has expanded considerably in the past years. Compared to conventional open or laparoscopic surgery, virtual reality (VR) training is an essential component in learning robot assisted surgery. However, for tasks to be implemented in a curriculum, the levels of validity should be studied for proficiency-based training. Therefore, this study was aimed to assess the validity evidence of advanced suturing tasks on a robot assisted VR simulator.

Method

Participants were voluntary recruited and divided in the robotic experienced, laparoscopic experienced or novice group, based on self-reported surgical experience. Subsequently, a questionnaire on a five-point Likert scale was completed to assess the content validity. Three component tasks of complex suturing were performed on the RobotiX simulator (Task1: tilted plane needle transfer, Task: 2 intracorporal suturing, Task 3: anastomosis needle transfer). Accordingly, the outcome of the parameters was used to assess construct validity between robotic experienced and novice participants. Composite scores (0–100) were calculated from the construct parameters and corresponding pass/fail scores with false positive (FP) and false negative (FN) percentages.

Results

Fifteen robotic experienced, 26 laparoscopic experienced and 29 novices were recruited. Overall content validity outcomes were scored positively on the realism (mean 3.7), didactic value (mean 4.0) and usability (mean 4.2). Robotic experienced participants significantly outperformed novices and laparoscopic experienced participants on multiple parameters on all three tasks of complex suturing. Parameters showing construct validity mainly consisted of movement parameters, needle precision and task completion time. Calculated composite pass/fail scores between robotic experienced and novice participants resulted for Task 1 in 73/100 (FP 21%, FN 5%), Task 2 in 85/100 (FP 28%, FN 4%) and Task 3 in 64/100 (FP 49%, FN 22%).

Conclusion

This study assessed the validity evidence on multiple levels of the three studied tasks. The participants score the RobotiX good on the content validity level. The composite pass/fail scores of Tasks 1 and 2 allow for proficiency-based training and could be implemented in a robot assisted surgery training curriculum.

Available only for authorised users

Intuitive Surgical Incorporated. Intuitive Surgical Annual Report. 2018. http://www.annualreports.com/Company/intuitive-surgical-inc. Accessed 28 Oct 2019.

Collins JW, Wisz P. Training in robotic surgery, replicating the airline industry. How far have we come? World J Urol. 2019;38:1645-51.

Schreuder HW, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RH. Training and learning robotic surgery, time for a more structured approach: a systematic review. Bjog. 2012;119(2):137–49.PubMedCrossRef

Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM, et al. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol. 2009;182(3):1126–32.PubMedCrossRef

Hanly EJ, Miller BE, Kumar R, Hasser CJ, Coste-Maniere E, Talamini MA, et al. Mentoring console improves collaboration and teaching in surgical robotics. J Laparoendosc Adv Surg Tech A. 2006;16(5):445–51.PubMedCrossRef

McDougall EM, Corica FA, Chou DS, Abdelshehid CS, Uribe CA, Stoliar G, et al. Short-term impact of a robot-assisted laparoscopic prostatectomy 'mini-residency' experience on postgraduate urologists' practice patterns. Int J Med Robot. 2006;2(1):70–4.PubMedCrossRef

Hart R, Karthigasu K. The benefits of virtual reality simulator training for laparoscopic surgery. Curr Opin Obstet Gynecol. 2007;19(4):297–302.PubMedCrossRef

Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis. Int J Surg (London, England). 2016;29:85–94.CrossRef

Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013;(8):Cd006575.

10.

Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. Bmj. 2009;338:b1802.PubMedPubMedCentralCrossRef

11.

Borgersen NJ, Naur TMH, Sorensen SMD, Bjerrum F, Konge L, Subhi Y, et al. Gathering validity evidence for surgical simulation: a systematic review. Ann Surg. 2018;267(6):1063–8.PubMedCrossRef

12.

Schout BM, Hendrikx AJ, Scheele F, Bemelmans BL, Scherpbier AJ. Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc. 2010;24(3):536–46.PubMedCrossRef

13.

Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, et al. Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc. 2005;19(12):1523–32.PubMedCrossRef

14.

Bric JD, Lumbard DC, Frelich MJ, Gould JC. Current state of virtual reality simulation in robotic surgery training: a review. Surg Endosc. 2016;30(6):2169–78.PubMedCrossRef

15.

Stefanidis D, Sevdalis N, Paige J, Zevin B, Aggarwal R, Grantcharov T, et al. Simulation in surgery: what's needed next? Ann Surg. 2015;261(5):846–53.PubMedCrossRef

16.

American Educational Research Association APA, National Council on Measurement in Education, Joint Committee on Standards for Educational and Psychological Testing. Standards for educational and psychological testing. Washington, DC: AERA; 2014.

17.

Leijte E, Arts E, Witteman B, Jakimowicz J, De Blaauw I, Botden S. Construct, content and face validity of the eoSim laparoscopic simulator on advanced suturing tasks. Surg Endosc. 2019;33:3635-43.

18.

Botden SM, Buzink SN, Schijven MP, Jakimowicz JJ. ProMIS augmented reality training of laparoscopic procedures face validity. Simul Healthc. 2008;3(2):97–102.PubMedCrossRef

19.

Botden SM, Berlage JT, Schijven MP, Jakimowicz JJ. Face validity study of the ProMIS augmented reality laparoscopic suturing simulator. Surg Technol Int. 2008;17:26–32.PubMed

20.

Likert R. A Technique for the measurement of attitudes. Arch Psychol. 1932;140:5-55.

21.

Jorgensen M, Konge L, Subhi Y. Contrasting groups' standard setting for consequences analysis in validity studies: reporting considerations. Adv Simul (London, England). 2018;3:5.CrossRef

22.

Whittaker G, Aydin A, Raveendran S, Dar F, Dasgupta P, Ahmed K. Validity assessment of a simulation module for robot-assisted thoracic lobectomy. Asian Cardiovasc Thorac Ann. 2019;27(1):23–9.PubMedCrossRef

23.

Watkinson W, Raison N, Abe T, Harrison P, Khan S, Van der Poel H, et al. Establishing objective benchmarks in robotic virtual reality simulation at the level of a competent surgeon using the RobotiX Mentor simulator. Postgrad Med J. 2018;94(1111):270–7.PubMedCrossRef

24.

Hovgaard LH, Andersen SAW, Konge L, Dalsgaard T, Larsen CR. Validity evidence for procedural competency in virtual reality robotic simulation, establishing a credible pass/fail standard for the vaginal cuff closure procedure. Surg Endosc. 2018;32(10):4200–8.PubMedCrossRef

25.

Hertz AM, George EI, Vaccaro CM, Brand TC. Head-to-head comparison of three virtual-reality robotic surgery simulators. JSLS. 2018;22(1):e2017.00081.PubMedPubMedCentralCrossRef

26.

Harrison P, Raison N, Abe T, Watkinson W, Dar F, Challacombe B, et al. The validation of a novel robot-assisted radical prostatectomy virtual reality module. J Surg Educ. 2018;75(3):758–66.PubMedCrossRef

27.

Omar I, Dilley J, Pucher P, Pratt P, Ameen T, Vale J, et al. The RobotiX simulator: face and content validation using the fundamentals of robotic surgery (FRS) curriculum. J Urol. 2017;197(4):e700–e1.

28.

Whittaker G, Aydin A, Raison N, Kum F, Challacombe B, Khan MS, et al. Validation of the RobotiX Mentor robotic surgery simulator. J Endourol. 2016;30(3):338–46.PubMedCrossRef

29.

Radboudumc. Radboudumc Commission Human Related Research. 2019. https://www.radboudumc.nl/over-het-radboudumc/kwaliteit-en-veiligheid/commissie-mensgebonden-onderzoek. Accessed 20 Feb 2020.

Title: Assessment of validity evidence for the RobotiX robot assisted surgery simulator on advanced suturing tasks
Authors: Erik Leijte
Ivo de Blaauw
Camiel Rosman
Sanne M. B. I. Botden
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2020
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-020-00839-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of validity evidence for the RobotiX robot assisted surgery simulator on advanced suturing tasks

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Haemorrhagic retroperitoneal paraganglioma initially manifesting as acute abdomen: a rare case report and literature review

Minimally invasive comprehensive treatment for granulomatous lobular mastitis

Odontoid fractures: impact of age and comorbidities on surgical decision making

Peptic ulcer perforation after cesarean section; case series and literature review

The use of ultrasound to locate a tethered surgical drain: a novel way to achieve fast removal

Laparoscopic resection of a primary diaphragmatic schwannoma: a case report and literature review