The effect of different training exercises on the performance outcome on the da Vinci Skills Simulator

Increasing usage of robotic surgery presents surgeons with the question of how to acquire the special skills required. This study aimed to analyze the effect of different exercises on their performance outcomes. This prospective study was conducted on the da Vinci Skills Simulator from December 2014 till August 2015. Sixty robotic novices were included and randomized to three groups of 20 participants each. Each group performed three different exercises with comparable difficulty levels. The exercises were performed three times in a row within two training sessions, with an interval of 1 week in between. On the final training day, two new exercises were added and a questionnaire was completed. Technical metrics of performance (overall score, time to complete, economy of motion, instrument collisions, excessive instrument force, instruments out of view, master work space range, drops, missed targets, misapplied energy time, blood loss and broken vessels) were recorded by the simulator software for further analysis. Training with different exercises led to comparable results in performance metrics for the final exercises among the three groups. A significant skills gain was recorded between the first and last exercises, with improved performance in overall score, time to complete and economy of motion for all exercises in all three groups. As training with different exercises led to comparable results in robotic training, the type of exercise seems to play a minor role in the outcome. For a robotic training curriculum, it might be important to choose exercises with comparable difficulty levels. In addition, it seems to be advantageous to limit the duration of the training to maintain the concentration throughout the entire session.