PURPOSE Current virtual reality-based (VR) simulators for robot-assisted minimally invasive surgery (RAMIS) training lack effective teaching and coaching. Our objective was to develop an automated teaching framework for VR training in RAMIS. Second, we wanted to study the effect of such real-time teaching cues on surgical technical skill acquisition. Third, we wanted to assess skill in terms of surgical technique in addition to traditional time and motion efficiency metrics. METHODS We implemented six teaching cues within a needle passing task on the da Vinci Skills Simulator platform (noncommercial research version). These teaching cues are graphical overlays designed to demonstrate ideal surgical technique, e.g., what path to follow while passing needle through tissue. We created three coaching modes: TEACH (continuous demonstration), METRICS (demonstration triggered by performance metrics), and USER (demonstration upon user request). We conducted a randomized controlled trial where the experimental group practiced using automated teaching and the control group practiced in a self-learning manner without automated teaching. RESULTS We analyzed data from 30 participants (14 in experimental and 16 in control group). After three practice repetitions, control group showed higher improvement in time and motion efficiency, while experimental group showed higher improvement in surgical technique compared to their baseline measurements. The experimental group showed more improvement than the control group on a surgical technique metric (at what angle is needle grasped by an instrument), and the difference between groups was statistically significant. CONCLUSION In a pilot randomized controlled trial, we observed that automated teaching cues can improve the performance of surgical technique in a VR simulator for RAMIS needle passing. Our study was limited by its recruitment of nonsurgeons and evaluation of a single configuration of coaching modes.

中文翻译：

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基于实时虚拟现实的教学线索对机器人辅助微创手术中学习针传递的影响：一项随机对照试验。

目的当前用于机器人辅助微创手术（RAMIS）培训的基于虚拟现实（VR）的模拟器缺乏有效的教学和指导。我们的目标是为RAMIS中的VR培训开发一个自动化的教学框架。其次，我们想研究这种实时教学提示对外科手术技术技能获取的影响。第三，除了传统的时间和运动效率指标外，我们还想根据手术技术评估技能。方法我们在达芬奇技能模拟器平台（非商业研究版）上通过了一个针传递任务，实现了六个教学提示。这些教学提示是图形叠加层，旨在演示理想的手术技术，例如，使针头穿过组织时遵循的路径。我们创建了三种教练模式：TEACH（连续演示），METRICS（由性能指标触发的演示）和USER（根据用户请求的演示）。我们进行了一项随机对照试验，其中实验组使用自动教学进行练习，对照组以自学方式进行练习，而无需自动化教学。结果我们分析了来自30名参与者的数据（实验组14名，对照组16名）。经过三个练习重复，对照组在时间和运动效率上都有较高的提高，而实验组与基线测量相比在手术技术上有更高的提高。实验组在手术技术指标（用器械抓住针的角度）方面显示出比对照组更大的改善，并且组之间的差异具有统计学意义。结论在一项随机对照试验中，我们观察到自动教学提示可以改善用于RAMIS针头穿刺的VR模拟器中手术技术的性能。我们的研究受到非外科医师招募和单一教练模式配置评估的限制。