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

Area of Science:

• Medical Simulation
• Surgical Education
• Robotic Surgery

Background:

• Virtual simulators are increasingly used for robotic surgery training.
• A lack of large randomized controlled trials (RCTs) hinders their adoption in surgical residency curricula.
• Current evidence on efficacy and skills transfer remains limited.

Purpose of the Study:

• To evaluate the level of evidence in published studies on the efficacy of virtual simulator training for robotic surgery.
• To assess the validity and skills transfer capabilities of widely used robotic surgery simulators.

Main Methods:

• A comprehensive literature search was conducted in April 2015 across major databases (PubMed, Web of Science, Scopus, Cochrane Library, Clinical Trials Database, Meta Register of Controlled Trials).
• Publications were assessed for relevance and level of evidence using the Oxford Centre for Evidence-Based Medicine classification.
• Studies on validity (RCTs, cohort studies) and skills transfer (RCTs, cohort studies) were included.

Main Results:

• Simulators demonstrated good face and content validity but varied methodologies limited construct validity assessment.
• No consensus exists on optimal tasks and metrics for da Vinci Skills Simulator and dV-Trainer.
• Limited evidence suggests potential skills transfer, with one RCT showing improved performance in urethrovesical anastomosis and a non-randomized study showing better outcomes in real patients, though these require further validation.

Conclusions:

• There is an urgent need for large, well-designed, multicenter RCTs to definitively establish the efficacy of virtual simulation for robotic surgery.
• Current evidence is insufficient to confirm the standard of safe clinical robotic surgery acquisition through virtual simulators.
• Further research is required to standardize training methodologies and validate skills transfer to patient care.