A Novel Drill Set for the Enhancement and Assessment of Robotic Surgical Performance

Background: There currently exist several training modules to improve performance during video-assisted surgery. The unique characteristics of robotic surgery make these platforms an inadequate environment for the development and assessment of robotic surgical performance. Methods: Expert surgeons (n = 4) (>50 clinical robotic procedures and >2 years of clinical robotic experience) were compared to novice surgeons (n = 17) (<5 clinical cases and limited laboratory experience) using the da Vinci Surgical System. Seven drills were designed to simulate clinical robotic surgical tasks. Performance score was calculated by the equation Time to Completion + (minor error) × 5 + (major error) × 10. The Robotic Learning Curve (RLC) was expressed as a trend line of the performance scores corresponding to each repeated drill. Results: Performance scores for experts were better than novices in all 7 drills (p<0.05). The RLC for novices reflected an improvement in scores (p<0.05). In contrast, experts demonstrated a flat RLC for 6 drills and an improvement in one drill (p = 0.027). Conclusion: This new drill set provides a framework for performance assessment during robotic surgery. The inclusion of particular drills and their role in training robotic surgeons of the future awaits larger validation studies. Robotics facilitates video-assisted surgery by offering a 3-D imaging system, camera stability, wrist-like instrument navigation, motion scaling, and improved ergonomics [1,2]. These characteristics improve operator performance on standard laparoscopic bench models and also allow for steeper learning curves among novice surgeons [3–6]. Nonetheless, the robotic surgery environment requires familiarity with the device’s innate lack of haptic feedback and altered grip strength control. Smooth coordination of the camera with the arms via seamless manipulation of the masters and the foot pedals must also be learned. These unique characteristics of robotic surgery demand novel drills in order to train surgeons and to appropriately assess their robotic surgical performance. C.Y. Ro et al. / A Novel Drill Set for the Enhancement and Assessment 419 Table 1. Mean Performance Scores Drill 4 Drill 1 Drill 2 Drill 3 Mobile Drill 5 Groups Precision Simple Rope Russian Mobile Beaded Minefield Suturing Beads Pass Roulette Precision String Pass Beads Novices 59.9 90.4 112.6 177.0 167.1 214.4 95.9 Experts 40.2 49.5 75.0 143.6 143.7 144.6 61.7 p-value <0.001 <0.001 <0.001 0.017 0.036 <0.001 <0.001