AUA 2013 - Session Highlights: Does virtual performance correlate with clinical skills in robotics? Investigating concurrent validity of da Vinci simulation with clinical performance

SAN DIEGO, CA USA ( - The role for simulation in surgical training has become a prominent and controversial topic. In particular the role for virtual reality simulation training for robotic surgery has been at the forefront. The aim of this study was to investigate the correlation between robotic simulation and clinical performance during robotic prostatectomy (RP) (concurrent validity).

auaTo evaluate this, nine robotic trainees were enrolled. A pre-study questionnaire documented self-reported prior robotic experience. Baseline performance was comprised of 6 virtual reality exercises on the da Vinci Skills Simulator (SIM). Subsequent robotic performance was comprised of a segment (bladder drop/endopelvic fascia) of RP, which was video-recorded and scored by a blinded expert robotic surgeon, using the validated six-metric Global Evaluative Assessment of Robotic Skills (GEARS).

The 9 participants were PGY8 (n=1), PGY-7 (n=3), PGY-6 (=2), PGY-5 (n=2) and PGY-4 (n=1). Of these, 7 (78%) had prior simulator training. The median number of RP cases performed was 40 (range 20-200). Both simulator and GEARS metrics were internally consistent. While several individual SIM metrics correlated to GEARS metrics (r=0.7-0.8, p<0.03), overall, SIM metrics did not predict total GEARS scores (p>0.05). For example, only SIM scores for controller clutching efficiency correlated with time required to drop bladder (r=0.7, p=0.03); otherwise it did not correlate with other clinical parameters. GEARS clinical scores, however, significantly correlated with prior clinical experience: number of bladders dropped (r=0.7, p=0.03), pedicles taken (r=0.7, p=0.02), and total number of RPs performed (r=0.7, p=0.04).

In summary, in this study by Syan and colleagues, no significant overall correlation was seen between simulator and operative performance. However, given that most participants had prior simulator training, this may suggest that simulation in its present form predicts only basic robotic skills, thereby emphasizing the ongoing need for more complex training simulation. GEARS scoring on baseline clinical skills correlated with prior robotic experience for both basic and advanced steps of RP, thus supporting its relevance in clinical assessment. Presented by Summet Syan, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Department of Urology, University of Southern California, Los Angeles, CA USA


Reported for by Samuel Juncal, MD; UC Irvine Medical Center, Orange, CA USA

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