Introduction
Methods
Participants
Simulators
EoSim cMIS AR simulator
General parameters | Definitions | ||
---|---|---|---|
Total time | Task time in seconds | ||
Instrument distance | Total instrument distance in meters | ||
EoSim parameters | |||
Off-screen | Sum of the off-screen percentage for each instrument (left and right) | ||
Working space | Average distance between the instruments in centimeter | ||
RobotiX parameters | |||
Needle drops | Number of times the needle was dropped | ||
Unnecessary piercing | Number of times the needle was inserted and retracted through the same entry point | ||
Total errors | Sum of errors occurred during the task such as instrument collisions and unnecessary piercing | ||
Off-screen | Number of times the instruments were out of view | ||
Instruments collisions | Number of times the instruments collided | ||
Composite scores | |||
cMIS | Task 1 | Time and distance | |
Task 2 | Time, distance, working space and off-screen | ||
Task 3 | Time per suture, distance per suture | ||
RAS | Task 1 | Time, suture breakage, needle drops and unnecessary piercing | |
Task 2 | Time, total distance, total number of movements, inaccurate punctures, instrument collisions and needle precision | ||
Task 3 | Time, distance left instrument, instruments collisions and precise needle passages |
RobotiX RAS VR simulator
Tasks
Protocol
Statistical analysis
Results
Demographics
Group 1 ( n = 16) | Group 2 ( n = 10) | Group 3 ( n = 17) | Total ( n = 43) | |||
---|---|---|---|---|---|---|
Mean age (SD) | 23 (1.6) | 24 (2.0) | 34 (4.6) | 28 (6.4) | ||
Sex (male/female) | 6/10 | 5/5 | 10/7 | 21/22 | ||
Dexterity (right/left) | 15/1 | 7/3 | 16/1 | 38/5 | ||
Total task training minutes (SD) | 327 (51) | 308 (78) | 83 (19) | |||
Surgical skill level | Medical student | 16 | 10 | 0 | 26 | |
Resident in training | 1–2 years | – | – | 2 | 2 | |
3–4 years | – | – | 9 | 9 | ||
5–6 years | – | – | 2 | 2 | ||
Surgeon | – | – | 4 | 4 | ||
Specialty | None | 16 | 10 | 0 | 26 | |
Surgery | – | – | 4 | 4 | ||
Pediatric | – | – | 3 | 3 | ||
Urology | – | – | 2 | 2 | ||
Gynecology | – | – | 8 | 8 | ||
Laparoscopic experience | Overall | 0 years | 16 | 10 | 0 | 26 |
> 0—5 years | – | – | 14 | 14 | ||
6—10 years | – | – | 1 | 1 | ||
> 10 years | – | – | 2 | 2 | ||
Basic procedures | 0 | 16 | 10 | 0 | 26 | |
> 0—30 | – | – | 5 | 5 | ||
31—100 | – | – | 7 | 7 | ||
> 100 | – | – | 5 | 5 | ||
Advanced procedures | 0 | 16 | 10 | 4 | 30 | |
> 0—10 | – | – | 7 | 7 | ||
11—50 | – | – | 5 | 5 | ||
> 50 | – | – | 1 | 1 |
Learning curve progression
Effects cMIS training on RAS performance
Overall
cMIS | Intracorporal suturing | Tilted plane | Anastomosis | |||
---|---|---|---|---|---|---|
Composite score | Time (s) | Composite score | Time (s) | Composite score | Time (s) | |
Group 1 (first cMIS then RAS) | 94.2 | 349 | 73.7 | 270 | 73.7 | 1141 |
(7.9) | (258) | (7.1) | (305) | (15.0) | 466 | |
Group 2 (RAS first then cMIS) | 96.2 | 287 | 72.8 | 258 | 81.3 | 965 |
(6.4) | (206) | (7.8) | (339) | (20.0) | (612) | |
p-value | ||||||
Group 1 vs 2 | 0.002 | 0.005 | 0.215 | 0.713 | 0.060 | 0.154 |
RAS | ||||||
Group 1 (first cMIS then RAS) | 91.5 | 163 | 60.8 | 345 | 71.5 | 393 |
(7.9) | (98) | (14.6) | (124) | (14.0) | (205) | |
Group 2 (RAS first then cMIS) | 89.2 | 193 | 58.3 | 345 | 74.5 | 384 |
(9.8) | (123) | (18.7) | (126) | (9.9) | (198) | |
Group 3 (RAS only) | 91.0 | 157 | 62 | 309 | 74.6 | 314 |
(10.2) | (108) | (14) | (105) | (9.0) | (105) | |
p-value | ||||||
Group 1 vs 2 | 0.004 | 0.004 | 0.516 | 0.996 | 0.309 | 0.846 |
Group 1 vs 3 | 0.531 | 0.419 | 0.633 | 0.118 | 0.194 | 0.021 |
Group 2 vs 3 | 0.040 | 0.001 | 0.330 | 0.169 | 0.950 | 0.084 |