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01-01-2018

Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads

Published in: Surgical Endoscopy | Issue 1/2018

Abstract

Background

While it is often claimed that virtual reality (VR) training system can offer self-directed and mentor-free skill learning using the system’s performance metrics (PM), no studies have yet provided evidence-based confirmation. This experimental study investigated what extent to which trainees achieved their self-learning with a current VR simulator and whether additional mentoring improved skill learning, skill transfer and cognitive workloads in robotic surgery simulation training.

Methods

Thirty-two surgical trainees were randomly assigned to either the Control-Group (CG) or Experiment-Group (EG). While the CG participants reviewed the PM at their discretion, the EG participants had explanations about PM and instructions on how to improve scores. Each subject completed a 5-week training using four simulation tasks. Pre- and post-training data were collected using both a simulator and robot. Peri-training data were collected after each session. Skill learning, time spent on PM (TPM), and cognitive workloads were compared between groups.

Results

After the simulation training, CG showed substantially lower simulation task scores (82.9 ± 6.0) compared with EG (93.2 ± 4.8). Both groups demonstrated improved physical model tasks performance with the actual robot, but the EG had a greater improvement in two tasks. The EG exhibited lower global mental workload/distress, higher engagement, and a better understanding regarding using PM to improve performance. The EG’s TPM was initially long but substantially shortened as the group became familiar with PM.

Conclusion

Our study demonstrated that the current VR simulator offered limited self-skill learning and additional mentoring still played an important role in improving the robotic surgery simulation training.

Ahmed K, Khan MS, Vats A, Nagpal K, Priest O, Patel V, Vecht JA, Ashrafian H, Yang GZ, Athanasiou T, Darzi A (2009) Current status of robotic assisted pelvic surgery and future developments. Int J Surg 7(5):431–440. doi:10.1016/j.ijsu.2009.08.008 CrossRefPubMed

Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting–the learning curve and beyond: initial 200 cases. J Urol 174(1):269–272. doi:10.1097/01.ju.0000162082.12962.40 CrossRefPubMed

Patel MN, Bhandari M, Menon M, Rogers CG (2009) Robotic-assisted partial nephrectomy. BJU Int 103(9):1296–1311. doi:10.1111/j.1464-410X.2009.08584.x CrossRefPubMed

Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, Brubaker L, Bresee C, Kenton K (2014) Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol 123(1):5–12. doi:10.1097/AOG.0000000000000006 CrossRefPubMedPubMedCentral

Martino MA, Berger EA, McFetridge JT, Shubella J, Gosciniak G, Wejkszner T, Kainz GF, Patriarco J, Thomas MB, Boulay R (2014) A comparison of quality outcome measures in patients having a hysterectomy for benign disease: robotic vs. non-robotic approaches. J Minim Invasive Gynecol 21(3):389–393. doi:10.1016/j.jmig.2013.10.008 CrossRefPubMed

Ma J, Shukla PJ, Milsom JW (2011) The evolving role of robotic colorectal surgery. Dis Colon Rectum 54(3):376–377. doi:10.1007/DCR.0b013e318204a8d5 CrossRefPubMed

Wilson EB (2009) The evolution of robotic general surgery. Scand J Surg 98(2):125–129CrossRefPubMed

You JY, Lee HY, Son GS, Lee JB, Bae JW, Kim HY (2013) Comparison of robotic adrenalectomy with traditional laparoscopic adrenalectomy with a lateral transperitoneal approach: a single-surgeon experience. Int J Med Robot Comput Assist Surg MRCAS 9(3):345–350. doi:10.1002/rcs.1497 CrossRef

Orady M, Hrynewych A, Nawfal AK, Wegienka G (2012) Comparison of robotic-assisted hysterectomy to other minimally invasive approaches. J Soc Laparoendosc Surg 16(4):542–548. doi:10.4293/108680812X13462882736899 CrossRef

10.

Dulan G, Rege RV, Hogg DC, Gilberg-Fisher KM, Arain NA, Tesfay ST, Scott DJ (2012) Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery 152(3):477–488. doi:10.1016/j.surg.2012.07.028 CrossRefPubMed

11.

Rashid HH, Leung YY, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L (2006) Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 68(1):75–79. doi:10.1016/j.urology.2006.01.057 CrossRefPubMed

12.

Antiel RM, Van Arendonk KJ, Reed DA, Terhune KP, Tarpley JL, Porterfield JR, Hall DE, Joyce DL, Wightman SC, Horvath KD, Heller SF, Farley DR (2012) Surgical training, duty-hour restrictions, and implications for meeting the Accreditation Council for Graduate Medical Education core competencies: views of surgical interns compared with program directors. Arch Surg 147(6):536–541. doi:10.1001/archsurg.2012.89 CrossRefPubMed

13.

Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Cools-Lartigue J, Kayssi A, Lipsman N, Elmi M, Kulkarni AV, Parshuram C, Mainprize T, Warren RJ, Fata P, Gorman MS, Feinberg S, Rutka J (2014) A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 259(6):1041–1053. doi:10.1097/SLA.0000000000000595 CrossRefPubMedPubMedCentral

14.

Lee JY, Mucksavage P, Sundaram CP, McDougall EM (2011) Best practices for robotic surgery training and credentialing. J Urol 185(4):1191–1197. doi:10.1016/j.juro.2010.11.067 CrossRefPubMed

15.

Liu JJ, Gonzalgo ML (2011) Minimally invasive training in urologic oncology. Arch Esp Urol 64(9):865–868PubMed

16.

Schreuder HW, Oei G, Maas M, Borleffs JC, Schijven MP (2011) Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience. Med Teach 33(2):105–115. doi:10.3109/0142159X.2011.550967 CrossRefPubMed

17.

Johnson E (2007) Surgical simulators and simulated surgeons: reconstituting medical practice and practitioners in simulations. Soc Stud Sci 37(4):585–608CrossRefPubMed

18.

Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM (2005) Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 241(2):364–372CrossRefPubMedPubMedCentral

19.

van Empel PJ, Verdam MG, Strypet M, van Rijssen LB, Huirne JA, Scheele F, Bonjer HJ, Meijerink WJ (2012) Voluntary autonomous simulator based training in minimally invasive surgery, residents’ compliance and reflection. J Surg Educ 69(4):564–570. doi:10.1016/j.jsurg.2012.04.011 CrossRefPubMed

20.

Chan B, Martel G, Poulin EC, Mamazza J, Boushey RP (2010) Resident training in minimally invasive surgery: a survey of Canadian department and division chairs. Surg Endosc 24(3):499–503. doi:10.1007/s00464-009-0611-3 CrossRefPubMed

21.

Rosenthal R, Schafer J, Hoffmann H, Vitz M, Oertli D, Hahnloser D (2013) Personality traits and virtual reality performance. Surg Endosc 27(1):222–230. doi:10.1007/s00464-012-2424-z CrossRefPubMed

22.

Pitzul KB, Grantcharov TP, Okrainec A (2012) Validation of three virtual reality Fundamentals of Laparoscopic Surgery (FLS) modules. Stud Health Technol Inform 173:349–355PubMed

23.

Brinkman WM, Buzink SN, Alevizos L, de Hingh IH, Jakimowicz JJ (2012) Criterion-based laparoscopic training reduces total training time. Surg Endosc 26(4):1095–1101. doi:10.1007/s00464-011-2005-6 CrossRefPubMed

24.

Kang SG, Yang KS, Ko YH, Kang SH, Park HS, Lee JG, Kim JJ, Cheon J (2012) A study on the learning curve of the robotic virtual reality simulator. J Laparoendosc Adv Surg Tech Part A 22(5):438–442. doi:10.1089/lap.2011.0452 CrossRef

25.

Lerner MA, Ayalew M, Peine WJ, Sundaram CP (2010) Does training on a virtual reality robotic simulator improve performance on the da Vinci surgical system? J Endourol 24(3):467–472. doi:10.1089/end.2009.0190 CrossRefPubMed

26.

Hung AJ, Zehnder P, Patil MB, Cai J, Ng CK, Aron M, Gill IS, Desai MM (2011) Face, content and construct validity of a novel robotic surgery simulator. J Urol 186(3):1019–1024. doi:10.1016/j.juro.2011.04.064 CrossRefPubMed

27.

Kenney PA, Wszolek MF, Gould JJ, Libertino JA, Moinzadeh A (2009) Face, content, and construct validity of dV-trainer, a novel virtual reality simulator for robotic surgery. Urology 73(6):1288–1292. doi:10.1016/j.urology.2008.12.044 CrossRefPubMed

28.

Perrenot C, Perez M, Tran N, Jehl JP, Felblinger J, Bresler L, Hubert J (2012) The virtual reality simulator dV-Trainer((R)) is a valid assessment tool for robotic surgical skills. Surg Endosc 26(9):2587–2593. doi:10.1007/s00464-012-2237-0 CrossRefPubMed

29.

Lee JY, Mucksavage P, Kerbl DC, Huynh VB, Etafy M, McDougall EM (2012) Validation study of a virtual reality robotic simulator–role as an assessment tool? J Urol 187(3):998–1002. doi:10.1016/j.juro.2011.10.160 CrossRefPubMed

30.

Brinkman WM, Luursema JM, Kengen B, Schout BM, Witjes JA, Bekkers RL (2013) da Vinci skills simulator for assessing learning curve and criterion-based training of robotic basic skills. Urology 81(3):562–566. doi:10.1016/j.urology.2012.10.020 CrossRefPubMed

31.

Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24(2):377–382. doi:10.1007/s00464-009-0578-0 CrossRefPubMed

32.

Stefanidis D, Hope WW, Scott DJ (2011) Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 25(7):2141–2146. doi:10.1007/s00464-010-1512-1 CrossRefPubMed

33.

Patel YR, Donias HW, Boyd DW, Pande RU, Amodeo JL, Karamanoukian RL, D’Ancona G, Karamanoukian HL (2003) Are you ready to become a robo-surgeon? Am Surg 69(7):599–603PubMed

34.

Shaligram A, Meyer A, Simorov A, Pallati P, Oleynikov D (2013) Survey of minimally invasive general surgery fellows training in robotic surgery. J Robot Surg 7(2):131–136. doi:10.1007/s11701-012-0355-2 CrossRefPubMed

35.

Hung AJ, Patil MB, Zehnder P, Cai J, Ng CK, Aron M, Gill IS, Desai MM (2012) Concurrent and predictive validation of a novel robotic surgery simulator: a prospective, randomized study. J Urol 187(2):630–637. doi:10.1016/j.juro.2011.09.154 CrossRefPubMed

36.

Finnegan KT, Meraney AM, Staff I, Shichman SJ (2012) da Vinci Skills Simulator construct validation study: correlation of prior robotic experience with overall score and time score simulator performance. Urology 80(2):330–335. doi:10.1016/j.urology.2012.02.059 CrossRefPubMed

37.

Johnston MJ, Paige JT, Aggarwal R, Stefanidis D, Tsuda S, Khajuria A, Arora S (2016) An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains. Am J Surg 211(1):214–225. doi:10.1016/j.amjsurg.2015.06.014 CrossRefPubMed

38.

Panait L, Rafiq A, Tomulescu V, Boanca C, Popescu I, Carbonell A, Merrell RC (2006) Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc 20(1):113–118. doi:10.1007/s00464-005-0113-x CrossRefPubMed

39.

Alaker M, Wynn GR, Arulampalam T (2016) Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis. Int J Surg 29:85–94. doi:10.1016/j.ijsu.2016.03.034 CrossRefPubMed

40.

Ahlborg L, Weurlander M, Hedman L, Nisel H, Lindqvist PG, Fellander-Tsai L, Enochsson L (2015) Individualized feedback during simulated laparoscopic training:a mixed methods study. Int J Med Educ 6:93–100. doi:10.5116/ijme.55a2.218b CrossRefPubMedPubMedCentral

41.

Paschold M, Huber T, Zeissig SR, Lang H, Kneist W (2014) Tailored instructor feedback leads to more effective virtual-reality laparoscopic training. Surg Endosc 28(3):967–973. doi:10.1007/s00464-013-3258-z CrossRefPubMed

Title: Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads
Publication date: 01-01-2018
Published in: Surgical Endoscopy / Issue 1/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5634-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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