Ex Vivo Porcine Model for Robotic Assisted Partial Nephrectomy Simulation at a High Volume Tertiary Center: Resident Perception and Validation Assessment Using the Global Evaluative Assessment of Robotic Skills (GEARS) Tool.

INTRODUCTION With increased demands on surgeon productivity and outcomes, residency robotics training increasingly relies on simulations. The objective of this study is to assess the validity and effectiveness of an ex-vivo porcine training model as a useful tool to improve surgical skill and confidence with robotic assisted partial nephrectomy (RAPN) amongst urology residents. Methods A 2.5 cm circular area of ex-vivo porcine kidneys was marked as the area of the "tumor." Tumor excision and renorraphy was performed by trainees using a da Vinci Si robot. All residents ranging from post graduate year (PGY) 2-5 participated in four training sessions during the 2017-2018 academic year. Each session was video recorded and scored using the global evaluative assessment of robotic skills (GEARS) by faculty members. Results Twelve residents completed the program. Initial mean GEARS score was 16.7 and improved by +1.4 with each subsequent session (p = 0.008). Initial mean excision, renorrhaphy, and total times were 8.2, 13.9, and 22.1 minutes, which improved respectively by 1.6, 2.0, and 3.6 minutes (all p < 0.001). Residents' confidence at performing RAPN and robotic surgery increased after completing the courses (p = 0.012 and p < 0.001, respectively). Overall, residents rated that this program has greatly contributed to their skill (4/5) and confidence (4.1/5) in robotic surgery. Conclusions An ex vivo porcine simulation model for RAPN and robotic surgery provides measurable improvement in GEARS score and reduction in procedural time, although significant differences for all PGY levels need to be confirmed with larger study participation. Adoption of this simulation in a urology residency curriculum may improve residents' skill and confidence in robotic surgery.