Augmented‐reality‐based skills training for robot‐assisted urethrovesical anastomosis: a multi‐institutional randomised controlled trial

Abstract

ObjectiveTo validate robot‐assisted surgery skills acquisition using an augmented reality (AR)‐based module for urethrovesical anastomosis (UVA).MethodsParticipants at three institutions were randomised to a Hands‐on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank‐sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross‐over group).ResultsA total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention.ConclusionTraining in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.

Utilization and Surgical Skill Transferability of the Simulator Robot to the Clinical Robot for Urology Surgery

“…On the contrary, the RoSS study found that the experimental group, trained on an augmented reality module, outperformed the control group on an inanimate model for UA, with significant differences using both GEARS criteria and their exclusive UA score [18] .…”

“…Two RCTs assessed the candidate's performance on the execution of the actual UA procedure on an inanimate model and cystotomy on an animal (swine) model [17,18] . One was conducted on the MdVT while the other was on the RoSS.…”

“…The UA score is unique from the GEARS score in that it was tailored towards the practical aspects of performing an UA, including assessing needle positioning, needle driving, suture placement, and tissue manipulation [18] . Therefore, it added value to the literature and provided an alternative insight into future research designs.…”

A Systematic Review of Virtual Reality Simulators for Robot-assisted Surgery

“…In validation studies, participants were recruited from the following specialties: urology (n = 15 studies) [10][11][12][13]15,16,21,[25][26][27]29,30,32,36,37]; gynecology (n = 1) [19]; urology and general surgery (n = 1) [24]; gynecology and general surgery (n = 1) [38]; urology, gynecology, and general surgery (n = 3) [20,22,31]; urology, gynecology, and cardiothoracic surgery (n = 1) [14]; and urology, otorhinolaryngology, cardiology, thoracic surgery, and gynecology (n = 1) [23]; in six studies, the specialty was not indicated [17,18,28,[33][34][35]. In skills transfer studies, participants were from gynecology (n = 3) [42][43][44]; urology (n = 2) [13,27]; general surgery (n = 1) [40]; and urology and gynecology (n = 1) [41]; in two studies the specialty was not reported [39,45].…”

“…In skills transfer studies, participants were from gynecology (n = 3) [42][43][44]; urology (n = 2) [13,27]; general surgery (n = 1) [40]; and urology and gynecology (n = 1) [41]; in two studies the specialty was not reported [39,45].…”