Evaluation of Robotic Cardiac Surgery Simulation Training: A Randomized Controlled Trial

Objective: To compare the currently available simulation training modalities used to teach robotic surgery.

Methods: Forty surgical trainees completed a standardized robotic 10-cm dissection of the internal thoracic artery and placed 3 sutures of a mitral valve annuloplasty in porcine models and were then randomized to a wet lab, a dry lab, a virtual reality lab, or a control group that received no additional training. All groups trained to a level of proficiency determined by 2 expert robotic cardiac surgeons. All assessments were evaluated using the Global Evaluative Assessment of Robotic Skills in a blinded fashion.

Results: Wet lab trainees showed the greatest improvement in time-based scoring and the objective scoring tool compared with the experts (mean, 24.9 ± 1.7 vs 24.9 ± 2.6; P = .704). The virtual reality lab improved their scores and met the level of proficiency set by our experts for all primary outcomes (mean, 24.9 ± 1.7 vs 22.8 ± 3.7; P = .103). Only the control group trainees were not able to meet the expert level of proficiency for both time-based scores and the objective scoring tool (mean, 24.9 ± 1.7 vs 11.0 ± 4.5; P < .001). The average duration of training was shortest for the dry lab and longest for the virtual reality simulation (1.6 hours vs 9.3 hours; P < .001).

Conclusions: We have completed the first randomized controlled trial to objectively compare the different training modalities of robotic surgery. Our data demonstrate the significant benefits of wet lab and virtual reality robotic simulation training and highlight key differences in current training methods. This study can help guide training programs in investing resources in cost-effective, high-yield simulation exercises.