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      Development and validation of non‐guided bladder‐neck and neurovascular‐bundle dissection modules of the RobotiX‐Mentor® full‐procedure robotic‐assisted radical prostatectomy virtual reality simulation

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          Abstract

          Background

          Full‐procedure virtual reality (VR) simulator training in robotic‐assisted radical prostatectomy (RARP) is a new tool in surgical education.

          Methods

          Description of the development of a VR RARP simulation model, (RobotiX‐Mentor®) including non‐guided bladder neck (ngBND) and neurovascular bundle dissection (ngNVBD) modules, and assessment of face, content, and construct validation of the ngBND and ngNVBD modules by robotic surgeons with different experience levels.

          Results

          Simulator and ngBND/ngNVBD modules were rated highly by all surgeons for realism and usability as training tool. In the ngBND‐task construct, validation was not achieved in task‐specific performance metrics. In the ngNVBD, task‐specific performance of the expert/intermediately experienced surgeons was significantly better than that of novices.

          Conclusions

          We proved face and content validity of simulator and both modules, and construct validity for generic metrics of the ngBND module and for generic and task‐specific metrics of the ngNVBD module.

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          Most cited references21

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

          No single large published randomized controlled trial (RCT) has confirmed the efficacy of virtual simulators in the acquisition of skills to the standard required for safe clinical robotic surgery. This remains the main obstacle for the adoption of these virtual simulators in surgical residency curricula.
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            An evidence-based virtual reality training program for novice laparoscopic surgeons.

            To develop an evidence-based virtual reality laparoscopic training curriculum for novice laparoscopic surgeons to achieve a proficient level of skill prior to participating in live cases. Technical skills for laparoscopic surgery must be acquired within a competency-based curriculum that begins in the surgical skills laboratory. Implementation of this program necessitates the definition of the validity, learning curves and proficiency criteria on the training tool. The study recruited 40 surgeons, classified into experienced (performed >100 laparoscopic cholecystectomies) or novice groups (<10 laparoscopic cholecystectomies). Ten novices and 10 experienced surgeons were tested on basic tasks, and 11 novices and 9 experienced surgeons on a procedural module for dissection of Calot triangle. Performance of the 2 groups was assessed using time, error, and economy of movement parameters. All basic tasks demonstrated construct validity (Mann-Whitney U test, P < 0.05), and learning curves for novices plateaued at a median of 7 repetitions (Friedman's test, P < 0.05). Expert surgeons demonstrated a learning rate at a median of 2 repetitions (P < 0.05). Performance on the dissection module demonstrated significant differences between experts and novices (P < 0.002); learning curves for novice subjects plateaued at the fourth repetition (P < 0.05). Expert benchmark criteria were defined for validated parameters on each task. A competency-based training curriculum for novice laparoscopic surgeons has been defined. This can serve to ensure that junior trainees have acquired prerequisite levels of skill prior to entering the operating room, and put them directly into practice.
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              Fundamentals of robotic surgery: a course of basic robotic surgery skills based upon a 14-society consensus template of outcomes measures and curriculum development.

              There is a need for a standardized curriculum for training and assessment of robotic surgeons to proficiency, followed by high-stakes testing (HST) for certification.
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                Author and article information

                Contributors
                jan.ebbing@usb.ch
                Journal
                Int J Med Robot
                Int J Med Robot
                10.1002/(ISSN)1478-596X
                RCS
                The International Journal of Medical Robotics + Computer Assisted Surgery
                John Wiley and Sons Inc. (Hoboken )
                1478-5951
                1478-596X
                13 November 2020
                April 2021
                : 17
                : 2 ( doiID: 10.1002/rcs.v17.2 )
                : e2195
                Affiliations
                [ 1 ] University Hospital Basel Department of Urology Basel Switzerland
                [ 2 ] Karolinska University Hospital Department of Urology Stockholm Sweden
                [ 3 ] Karolinska Institutet Department of Molecular Medicine and Surgery (MMK) Stockholm Sweden
                [ 4 ] Icahn School of Medicine at Mount Sinai Department of Urology New York NY USA
                [ 5 ] Karolinska Institutet Unit of Biostatistics Institute of Environmental Medicine (IMM) Stockholm Sweden
                [ 6 ] Charité – University Hospital Medical Department Division of Nephrology Berlin Germany
                [ 7 ] University College London Hospital London England
                Author notes
                [*] [* ] Correspondence

                Jan Ebbing, University Hospital Basel, Department of Urology, Spitalstrasse 21, 4031 Basel, Switzerland.

                Email: jan.ebbing@ 123456usb.ch

                Author information
                https://orcid.org/0000-0002-8680-133X
                Article
                RCS2195
                10.1002/rcs.2195
                7988553
                33124140
                b90139d9-2bf7-4cff-91b6-e689a0bf64b6
                © 2020 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2020
                : 27 August 2020
                : 27 October 2020
                Page count
                Figures: 2, Tables: 7, Pages: 13, Words: 8451
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                April 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.0 mode:remove_FC converted:24.03.2021

                Surgery
                education,prostate,robotic‐assisted radical prostatectomy,simulator,training,validation,virtual reality

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