Valdis Matthew, Chu Michael W A, Schlachta Christopher M, Kiaii Bob
From the *Division of Cardiac Surgery, and †Division of General Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada.
Innovations (Phila). 2015 Nov-Dec;10(6):383-8. doi: 10.1097/IMI.0000000000000222.
Robotic cardiac surgery training has relied entirely on classical methods of surgical teaching. We sought to evaluate the impact of a virtual reality (VR) simulation curriculum to improve skill acquisition in robotic cardiac surgery.
We randomly assigned 20 surgical trainees to undergo a 9-exercise VR curriculum on a robotic surgical simulator or a control group that received no additional training. The trainees were then evaluated in a blinded fashion by assessing their de-identified video recordings of the following: (1) standardized robotic internal thoracic artery harvest and (2) mitral valve annuloplasty performed in porcine models, using a validated time-based scoring system and an objective intraoperative scoring tool. Postintervention assessments were compared to baseline.
Trainees randomized to the VR group were faster than the control group for both the internal thoracic artery harvest (957.3 ± 98.9 vs. 749.1 ± 171.9; P = 0.004) and mitral annuloplasty (580.4 ± 14.4 vs. 463.8 ± 86.4; P < 0.001) and scored significantly higher with the intraoperative scoring tool (22.8 ± 2.7 vs. 11.0 ± 4.5; P < 0.001). Additionally, the VR group achieved a proficiency level similar to our experts for both time-based scores (P = 0.624 and P = 0.967), and the intraoperative assessment (P = 0.110), whereas the control group was not able to meet this level of proficiency for any of the primary outcomes. The average duration of training to successfully complete all required tasks was 9.3 hours.
We have demonstrated that a VR simulation curriculum can significantly improve the efficiency and quality of learning in robotic cardiac surgery. Further evaluation of this curriculum is required for its widespread implementation in surgical training (ClinicalTrials.gov, NCT#02357056).
机器人心脏手术培训完全依赖于传统的外科教学方法。我们试图评估虚拟现实（VR）模拟课程对提高机器人心脏手术技能掌握的影响。
我们将20名外科实习生随机分为两组，一组在机器人手术模拟器上接受9项练习的VR课程，另一组为对照组，不接受额外培训。然后，通过评估他们以下内容的匿名视频记录，以盲法对实习生进行评估：（1）标准化的机器人胸廓内动脉采集，以及（2）在猪模型中进行的二尖瓣环成形术，使用经过验证的基于时间的评分系统和客观的术中评分工具。将干预后的评估结果与基线进行比较。
随机分配到VR组的实习生在胸廓内动脉采集（957.3±98.9对749.1±171.9；P = 0.004）和二尖瓣环成形术（580.4±14.4对463.8±86.4；P < 0.001）方面均比对照组更快，并且在术中评分工具上得分显著更高（22.8±2.7对11.0±4.5；P < 0.001）。此外，VR组在基于时间的评分（P = 0.624和P = 0.967）以及术中评估（P = 0.110）方面达到了与我们的专家相似的熟练水平，而对照组在任何主要结果方面都未能达到这一熟练水平。成功完成所有所需任务的平均培训时长为9.3小时。
我们已经证明，VR模拟课程可以显著提高机器人心脏手术学习的效率和质量。该课程在外科培训中的广泛应用还需要进一步评估（ClinicalTrials.gov，NCT编号：02357056）。
