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Predictive Validity of a Training Protocol Using a Robotic Surgery Simulator

Culligan, Patrick MD*; Gurshumov, Emil MD*; Lewis, Christa DO*; Priestley, Jennifer PhD; Komar, Jodie BSN*; Salamon, Charbel MD*

Female Pelvic Medicine & Reconstructive Surgery: January/February 2014 - Volume 20 - Issue 1 - p 48–51
doi: 10.1097/SPV.0000000000000045
Original Articles

Background Robotic surgery simulation may provide a way for surgeons to acquire specific robotic surgical skills without practicing on live patients.

Methods Five robotic surgery experts performed 10 simulator skills to the best of their ability, and thus, established expert benchmarks for all parameters of these skills. A group of credentialed gynecologic surgeons naive to robotics practiced the simulator skills until they were able to perform each one as well as our experts. Within a week of doing so, they completed robotic pig laboratory training, after which they performed supracervical hysterectomies as their first-ever live human robotic surgery. Time, blood loss, and blinded assessments of surgical skill were compared among the experts, novices, and a group of control surgeons who had robotic privileges but no simulator exposure. Sample size estimates called for 11 robotic novices to achieve 90% power to detect a 1 SD difference between operative times of experts and novices (α = 0.05).

Results Fourteen novice surgeons completed the study—spending an average of 20 hours (range, 9.7–38.2 hours) in the simulation laboratory to pass the expert protocol. The mean operative times for the expert and novices were 20.2 (2.3) and 21.7 (3.3) minutes, respectively (P = 0.12; 95% confidence interval, −1.7 to 4.7), whereas the mean time for control surgeons was 30.9 (0.6) minutes (P < 0.0001; 95% confidence interval, 6.3–12.3). Comparisons of estimated blood loss (EBL) and blinded video assessment of skill yielded similar differences between groups.

Conclusions Completing this protocol of robotic simulator skills translated to expert-level surgical times during live human surgery. As such, we have established predictive validity of this protocol.

From the Department of Urogynecology, Atlantic Health System, Morristown, NJ; and †Department of Mathematics, Kennesaw State University, Kennesaw, GA.

Reprints: Patrick Culligan, MD, Department of Urogynecology, Atlantic Health System, 435 South St, Suite 370, Morristown, NJ 07960. E-mail:

Dr Culligan is a paid consultant for CR Bard, Boston Scientific, and Intuitive Surgical. He also receives research support from CR Bard, Boston Scientific, American Medical Systems, and Intuitive Surgical. Dr Salamon is a paid consultant for American Medical Systems. The other authors have declared they have no conflicts of interest.

This research was funded by Intuitive Surgical.

© 2014 by Lippincott Williams & Wilkins