Robotic surgery virtual reality simulator shows early promise

Given the increasing demand for clinical use of the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA), its availability for use as a training tool is becoming scarce. Additionally, the expense of the system can make administrators nervous about allowing residents or inexperienced surgeons to practice on it. For these reasons, stand-alone virtual reality robotic trainers are being developed.

"A virtual reality trainer allows one to supplement robotic training, as it is often difficult to have da Vinci training labs," said study co-author Steven Lucas, MD, a urologic laparoscopy fellow at Indiana University, Indianapolis, working with Michelle Lerner, MD, Chandru Sundaram, MD, and colleagues.

The trainees were then divided into two groups. One group repeated the same tasks over four training sessions using a da Vinci robot. The other group performed a different set of robotically oriented tasks on the dV-Trainer over four training sessions. Following their respective training sessions, both groups repeated the baseline tasks on the da Vinci console, and the post-training results were compared to baseline.

Simulator offers translatable skills

Both groups showed improvements from baseline in most of the metrics measured. The mean improvements for each group were then compared to evaluate the effectiveness of the training platform. With a few minor exceptions, the groups showed equal improvement.

"Subjects who trained on the Mimic virtual reality trainer demonstrated similar improvement in performing tasks on the da Vinci surgical system as those who trained solely on the da Vinci," Dr Lucas said. "Skills obtained through training on a robotic virtual reality trainer translate to improvement of per-formance on the da Vinci system."

If further studies confirm that virtual reality trainers are equally as effective as training on the robot itself, they could facilitate the training of residents and potentially reduce morbidity to patients by reducing surgical errors during the learning curve.

However, it remains unclear whether improvements in dry lab exercises translate into better performance on actual surgical procedures. Currently, the dV-Trainer is limited to only a few fairly simple exercises, such as manipulating rings and putting block letters into a board. As the technology improves, the hope is that the tasks will become more sophisticated.

"Virtual reality trainers have the future potential of providing residents the means to perform entire procedures in a practice setting-experience that cannot be gained using da Vinci training labs," Dr. Lucas said.

At $100,000, the dV-Trainer is not inexpensive. Its cost may put the trainer beyond the budget of some hospitals and residency programs, but it is possible that this price will come down with improvements in technology and higher volume of sales.