From Virtual Reality to High-Fidelity Silicone Models: A Pilot Pathway for Training Vascular Surgeons in Robotic Skills

This pilot study evaluated the learning curve of vascular surgeons undergoing structured VR simulator training and assessed the feasibility of performing a robotic vascular anastomosis within a team lacking prior laparoscopic or robotic experience.

Three vascular surgeons completed a structured curriculum on the RobotiX Mentor VR simulator, followed by a robotic aorto-aortic bypass with a Dacron graft performed on a high-fidelity pulsatile silicone model using the da Vinci surgical system. These procedures were compared with an open-technique anastomosis performed on the same model, with outcomes assessed via the Objective Structured Assessment of Technical Skills (OSATS), operative time, and leakage rate.

Surgeons completed a median of 248 training sessions across 77 distinct cases to reach the 20-hour required for robotic surgery certification, with proficiency achieved after 14-19 hours of training. Robotic anastomosis was associated with lower OSATS scores (34.5 [IQR 33.25-35.375] vs 40 [IQR 40-40]; P=0.003) and longer operative times (47 [IQR 41.5-57.75] vs 12 minutes [IQR 11.0-13.75]) relative to open surgery. Leakage rates did not differ between techniques (2 mL [IQR 0-4] vs 0 mL; P=0.087), and final product quality was considered acceptable, with a median score of 23 out of 25.

Vascular surgeons without prior robotic or laparoscopic experience were able to acquire basic robotic vascular anastomosis skills through a structured curriculum combining VR and high-fidelity silicone simulation. Despite longer operative times relative to open surgery, technical quality and leakage rates were comparable between techniques.