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Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance

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Abstract

To understand the influence of proctored guidance versus simulator generated guidance (SGG) on the acquisition dexterity skills in novice surgeons learning RAS (robot assisted surgery). Prospective non-blinded 3-arm randomised controlled trial (RTC). Exclusion criteria: previous experience in RAS or robotic surgery simulation. The participants were assigned to three different intervention groups and received a different form of guidance: (1) proctored guidance, (2) simulator generated guidance, (3) no guidance, during training on virtual reality (VR) simulator. All participants were asked to complete multiple questionnaires. The training was the same in all groups with the exception of the intervention part. Catharina Hospital Eindhoven, The Netherlands. A total of 70 Dutch medical students, PhD-students, and surgical residents were included in the study. The participants were randomly assigned to one of the three groups. Overall, all the participants showed a significant improvement in their dexterity skills after the training. There was no significant difference in the improvement of surgical skills between the three different intervention groups. The proctored guidance group reported a higher participant satisfaction compared to the simulator-generated guidance group, which could indicate a higher motivation to continue the training. This study showed that novice surgeons. Significantly increase their dexterity skills in RAS after a short time of practicing on simulator. The lack of difference in results between the intervention groups could indicate there is a limited impact of “human proctoring” on dexterity skills during surgical simulation training. Since there is no difference between the intervention groups the exposure alone of novice surgeons to the robotic surgery simulator could possibly be sufficient to achieve a significant improvement of dexterity skills during the initial steps of RAS learning.

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Abbreviations

BPR:

Basic proficiency requirements for the safe use of robotic surgery

RAS:

Robot assisted surgery

RARP:

Robot-assisted radical prostatectomy

OR:

Operating room

SBE:

Simulation-based education

SGG:

Simulator generated guidance

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Acknowledgements

The authors thank all participants in the study and O. Frenkel and the team at 3Dsystems for their support during the study.

Funding

This study was performed with funding of Astellas Pharma Europe Ltd. and Olympus Netherlands B.V. The parties had no influence zo ever on the design, performance and analysis of the study.

Author information

Author notes

  1. A. J. W. Beulens and Y. Hashish (shared first authorship) contributed equally to this paper.

Authors and Affiliations

  1. Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

    A. J. W. Beulens & C. Wagner

  2. Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    A. J. W. Beulens, Y. A. F. Hashish & E. L. Koldewijn

  3. Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands

    W. M. Brinkman

  4. Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy

    P. Umari

  5. Urology Department, University of Modena & Reggio Emilia, Modena, Italy

    S. Puliatti

  6. Orsi Academy, Melle, Belgium

    S. Puliatti

  7. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium

    S. Puliatti

  8. Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    A. J. M. Hendrikx

  9. Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    J. P. van Basten

  10. School of Health Professions Education, Maastricht University, Maastricht, The Netherlands

    J. J. G. van Merriënboer

  11. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    H. G. Van der Poel

  12. Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands

    C. H. Bangma

  13. Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands

    C. Wagner

Authors
  1. A. J. W. Beulens
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  2. Y. A. F. Hashish
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  3. W. M. Brinkman
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  6. E. L. Koldewijn
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  7. A. J. M. Hendrikx
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  8. J. P. van Basten
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  9. J. J. G. van Merriënboer
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  10. H. G. Van der Poel
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  12. C. Wagner
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Corresponding author

Correspondence to A. J. W. Beulens.

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Conflict of interest

Drs. Beulens, Miss. Hashish, Dr. Brinkman, Dr. van der Poel, Dr. Umari, Dr. Puliatti, Dr. van Basten, Dr. Hendrikx, Dr. Koldewijn, Prof. van Merrienboer, Prof Bangma, and Prof. Wagner have no conflicts of interest to disclose.

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Appendices

Appendix 1

See Table 7

Table 7 Pre-intervention vesicourethral anastomosis simulation exercise scores
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Appendix 2

See Table 8

Table 8 Comparison of the pre-intervention and post-intervention vesicourethral anastomosis simulation exercise overall scores
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Appendix 3

See Table 9

Table 9 Comparison of the pre-intervention and post-intervention vesicourethral anastomosis simulation exercise scores per group
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Beulens, A.J.W., Hashish, Y.A.F., Brinkman, W.M. et al. Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance. J Robotic Surg 15, 397–428 (2021). https://doi.org/10.1007/s11701-020-01118-y

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  • DOI: https://doi.org/10.1007/s11701-020-01118-y

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