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Evaluation of Robotic Cardiac Surgery Training Modalities
Matthew Valdis, Michael Chu, Christopher Schlachta, Bob Kiaii.
Univesity of Western Ontario, London, ON, Canada.

OBJECTIVE: Implementation of training exercises, such as wet labs, dry labs and virtual reality simulation, have improved the efficiency of training and shortened learning curves of robotic cardiac surgery. These different training modalities have been individually validated as reliable training methods, however, despite the fact that implementing a robotic training program is a costly and resource heavy endeavour, no objective comparison exists to help determine the efficacy and cost-effectiveness of these training modalities.
METHODS: 40 surgical trainees were observed while they completed a standardized robotic 10cm dissection of the internal thoracic artery and placed three sutures of a mitral valve annuloplasty in porcine models. The subjects were then randomized to one of four training streams; a wet lab where the same two tasks were repeated, a dry lab or virtual reality simulation curriculum focusing on basic robotic surgical skills and a control group that received no additional training. All of the groups were allowed to train to a level of proficiency, determined by the performance of three expert robotic surgeons. After completing the training in their assigned stream, the trainees repeated the original assessments. The initial and final assessments were evaluated by expert surgeons using the Global Evaluative Assessment of Robotic Skills (GEARS) in a blinded fashion.
RESULTS: All three training streams were effective methods for learning robotic surgical skills compared to expert performances, however subjects assigned to the control group were not able to meet the level set by our expert surgeons. The average duration of training required to reach proficiency was least for the dry lab and most for the virtual reality simulation (2.5hr vs. 9.5hr, p<0.05). No significant difference was detected in our objective GEARS assessment between the three training groups, but all outperformed the control group.
CONCLUSIONS: Here we have completed the first randomized controlled trial to objectively compare the efficacy of different training modalities in robotic cardiac surgery. This work highlights key differences in current training methods and will serve to help training programs invest resources in cost-effective, high yield simulation methods to improve training for new robotic cardiac surgeons.

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