Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
J Am Coll Surg. 2013 Jun;216(6):1181-92. doi: 10.1016/j.jamcollsurg.2013.02.012. Epub 2013 Apr 11.
BACKGROUND: Preoperative simulation warm-up has been shown to improve performance and reduce errors in novice and experienced surgeons, yet existing studies have only investigated conventional laparoscopy. We hypothesized that a brief virtual reality (VR) robotic warm-up would enhance robotic task performance and reduce errors. STUDY DESIGN: In a 2-center randomized trial, 51 residents and experienced minimally invasive surgery faculty in General Surgery, Urology, and Gynecology underwent a validated robotic surgery proficiency curriculum on a VR robotic simulator and on the da Vinci surgical robot (Intuitive Surgical Inc). Once they successfully achieved performance benchmarks, surgeons were randomized to either receive a 3- to 5-minute VR simulator warm-up or read a leisure book for 10 minutes before performing similar and dissimilar (intracorporeal suturing) robotic surgery tasks. The primary outcomes compared were task time, tool path length, economy of motion, technical, and cognitive errors. RESULTS: Task time (-29.29 seconds, p = 0.001; 95% CI, -47.03 to -11.56), path length (-79.87 mm; p = 0.014; 95% CI, -144.48 to -15.25), and cognitive errors were reduced in the warm-up group compared with the control group for similar tasks. Global technical errors in intracorporeal suturing (0.32; p = 0.020; 95% CI, 0.06-0.59) were reduced after the dissimilar VR task. When surgeons were stratified by earlier robotic and laparoscopic clinical experience, the more experienced surgeons (n = 17) demonstrated significant improvements from warm-up in task time (-53.5 seconds; p = 0.001; 95% CI, -83.9 to -23.0) and economy of motion (0.63 mm/s; p = 0.007; 95% CI, 0.18-1.09), and improvement in these metrics was not statistically significantly appreciated in the less-experienced cohort (n = 34). CONCLUSIONS: We observed significant performance improvement and error reduction rates among surgeons of varying experience after VR warm-up for basic robotic surgery tasks. In addition, the VR warm-up reduced errors on a more complex task (robotic suturing), suggesting the generalizability of the warm-up.
背景：术前模拟热身已被证明可以提高新手和经验丰富的外科医生的表现并减少错误，但现有研究仅调查了传统腹腔镜手术。我们假设简短的虚拟现实（VR）机器人热身将增强机器人任务的表现并减少错误。
研究设计：在一项 2 中心随机试验中，51 名普外科、泌尿科和妇科的住院医师和经验丰富的微创外科教员在 VR 机器人模拟器和达芬奇手术机器人（直觉外科公司）上接受了经过验证的机器人手术熟练程度课程。一旦他们成功达到性能基准，外科医生就会被随机分配接受 3-5 分钟的 VR 模拟器热身，或在进行类似和不同（腔内缝合）机器人手术任务之前阅读 10 分钟的休闲书籍。主要比较结果是任务时间、工具路径长度、运动经济性、技术和认知错误。
结果：与对照组相比，热身组在类似任务中的任务时间（-29.29 秒，p=0.001；95%置信区间，-47.03 至-11.56）、路径长度（-79.87 毫米；p=0.014；95%置信区间，-144.48 至-15.25）和认知错误减少。在腔内缝合的非相似 VR 任务后，全球技术错误（0.32；p=0.020；95%置信区间，0.06-0.59）减少。当根据早期机器人和腹腔镜临床经验对外科医生进行分层时，经验更丰富的外科医生（n=17）在任务时间（-53.5 秒；p=0.001；95%置信区间，-83.9 至-23.0）和运动经济性（0.63 毫米/秒；p=0.007；95%置信区间，0.18-1.09）方面取得了显著的改善，而在经验较少的队列（n=34）中，这些指标的改善并不显著。
结论：我们观察到在基本机器人手术任务中，经验丰富和经验较少的外科医生在 VR 热身之后表现均有显著提高，错误率降低。此外，VR 热身减少了更复杂任务（机器人缝合）的错误，表明热身具有普遍性。
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