Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Surg Endosc. 2018 Oct;32(10):4200-4208. doi: 10.1007/s00464-018-6165-5. Epub 2018 Mar 30.
BACKGROUND: The use of robotic surgery for minimally invasive procedures has increased considerably over the last decade. Robotic surgery has potential advantages compared to laparoscopic surgery but also requires new skills. Using virtual reality (VR) simulation to facilitate the acquisition of these new skills could potentially benefit training of robotic surgical skills and also be a crucial step in developing a robotic surgical training curriculum. The study's objective was to establish validity evidence for a simulation-based test for procedural competency for the vaginal cuff closure procedure that can be used in a future simulation-based, mastery learning training curriculum. METHODS: Eleven novice gynaecological surgeons without prior robotic experience and 11 experienced gynaecological robotic surgeons (> 30 robotic procedures) were recruited. After familiarization with the VR simulator, participants completed the module 'Guided Vaginal Cuff Closure' six times. Validity evidence was investigated for 18 preselected simulator metrics. The internal consistency was assessed using Cronbach's alpha and a composite score was calculated based on metrics with significant discriminative ability between the two groups. Finally, a pass/fail standard was established using the contrasting groups' method. RESULTS: The experienced surgeons significantly outperformed the novice surgeons on 6 of the 18 metrics. The internal consistency was 0.58 (Cronbach's alpha). The experienced surgeons' mean composite score for all six repetitions were significantly better than the novice surgeons' (76.1 vs. 63.0, respectively, p < 0.001). A pass/fail standard of 75/100 was established. Four novice surgeons passed this standard (false positives) and three experienced surgeons failed (false negatives). CONCLUSION: Our study has gathered validity evidence for a simulation-based test for procedural robotic surgical competency in the vaginal cuff closure procedure and established a credible pass/fail standard for future proficiency-based training.
背景：在过去十年中，微创手术中使用机器人手术的情况大大增加。与腹腔镜手术相比，机器人手术具有潜在优势，但也需要新的技能。使用虚拟现实（VR）模拟来促进这些新技能的获取可能有助于培训机器人手术技能，并且是开发机器人手术培训课程的关键步骤。本研究的目的是为阴道袖口关闭手术的基于模拟的程序能力测试建立有效性证据，该测试可用于未来基于模拟的精通学习培训课程。
方法：招募了 11 名没有机器人手术经验的新手妇科医生和 11 名经验丰富的妇科机器人外科医生（>30 例机器人手术）。在熟悉 VR 模拟器后，参与者完成了模块“引导阴道袖口关闭”六次。对 18 个预选模拟器指标进行了有效性证据研究。使用 Cronbach's alpha 评估内部一致性，并根据具有两组之间显著区分能力的指标计算综合得分。最后，使用对比组方法建立通过/失败标准。
结果：在 18 项指标中，有经验的外科医生在 6 项指标上的表现明显优于新手外科医生。内部一致性为 0.58（Cronbach's alpha）。经验丰富的外科医生在所有六次重复的平均综合得分明显高于新手外科医生（分别为 76.1 和 63.0，p<0.001）。建立了 75/100 的通过/失败标准。有 4 名新手外科医生通过了这一标准（假阳性），而有 3 名有经验的外科医生失败（假阴性）。
结论：我们的研究为阴道袖口关闭手术的基于模拟的机器人手术程序能力测试收集了有效性证据，并为未来基于熟练度的培训建立了可靠的通过/失败标准。
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