Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial

Area of Science:

• Surgical Education
• Robotic Surgery
• Virtual Reality Simulation

Background:

• Intraoperative errors are linked to surgeon skill, which can decline with inactivity.
• Virtual reality (VR) simulation offers a potential method to maintain and enhance surgeon technical skills.
• Identifying optimal VR warm-up protocols is crucial for pre-operative skill priming.

Purpose of the Study:

• To determine the most effective virtual reality (VR) warm-up curriculum for priming surgeon technical skill.
• To validate the impact of a VR warm-up on surgeon performance in actual robot-assisted surgery.

Main Methods:

• Surgeons participated in VR warm-up trials on the da Vinci Skills Simulator to identify optimal curricula.
• The optimal curriculum was selected based on task completion time and technical skill assessment via video review.
• The effect of the optimal VR warm-up was evaluated in robot-assisted surgeries using blinded performance reviews and motion metrics.

Main Results:

• A VR warm-up curriculum focusing solely on the Running Suture task was identified as optimal, with participants being 31.3 seconds faster and scoring higher on the Global Evaluative Assessment of Robotic Skills.
• In a subsequent trial with 34 surgeons performing 347 surgeries, the VR warm-up intervention did not lead to statistically significant differences in technical skill during the initial stages of surgery.

Conclusions:

• A robotic virtual reality (VR) warm-up protocol, even when optimized, does not demonstrably improve surgeon technical skill in the initial phases of robot-assisted surgery.
• Further research may be needed to explore different VR training paradigms or other methods to address skill decay in robotic surgery.