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Effect of real-time virtual reality-based teaching cues on learning needle passing for robot-assisted minimally invasive surgery: a randomized controlled trial

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

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.

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Notes

  1. Henceforth, in this paper, surgical skill will refer to technical skill specifically.

  2. https://www.facs.org/education/program/resident-skills; Scott et al. [22].

  3. Illustrations are provided as Electronic Supplementary Material 2, 3, and 4.

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Acknowledgements

We thank Anusha Balan, Sina Parastegari, Prasad, and Ashwin from Intuitive Surgical Inc. (ISI, Sunnyvale, California) for their help with the dVSim. We thank Simon DiMaio (ISI) for his feedback and helpful inputs. We thank Anthony Jarc (ISI) for help with the study IRB logistics. We thank Umut and Daniel from SenseGraphics AB (Kista, Sweden) for their support related to the H3DAPI.

Funding

Anand Malpani was supported through a Link Foundation fellowship award for advanced simulation and training.

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Authors and Affiliations

  1. Johns Hopkins University, 3400 N Charles St., Baltimore, MD, 21218, USA

    Anand Malpani, S. Swaroop Vedula, Gregory D. Hager & Russell H. Taylor

  2. Intuitive Surgical Inc., 1020 Kifer Road, Sunnyvale, CA, 94086, USA

    Anand Malpani & Henry C. Lin

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  1. Anand Malpani
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  2. S. Swaroop Vedula
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Corresponding author

Correspondence to Anand Malpani.

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Conflict of interest

Anand Malpani was employed as an intern at Intuitive Surgical Inc. (Sunnyvale, California, USA) during part of this work. Henry C. Lin is an employee at Intuitive Surgical Inc. (Sunnyvale, California, USA). Intuitive Surgical Inc. manufactures the da Vinci Skills Simulator that was used as the platform to test the work on. Gregory D. Hager and Russell H. Taylor have received funding from Intuitive Surgical Inc. previously for other research projects. Johns Hopkins University and Intuitive Surgical Inc. have an ongoing partnership to support research on the surgical robots.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Western IRB, Protocol 20121049) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Thanks to the Link Foundation Fellowship for Advanced Simulation and Training awarded to Anand Malpani. This work is part of Anand Malpani’s Ph.D. Thesis [16].

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Malpani, A., Vedula, S.S., Lin, H.C. et al. Effect of real-time virtual reality-based teaching cues on learning needle passing for robot-assisted minimally invasive surgery: a randomized controlled trial. Int J CARS 15, 1187–1194 (2020). https://doi.org/10.1007/s11548-020-02156-5

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