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Título

FUNDAMENTAL TECHNICAL COMPETENCIES IN ROBOTIC SURGERY: CONTEMPORARY VALIDATION PROCESS OF AN EX VIVO TRAINING MODEL

Resumo

Introduction: Live animals or human cadavers are the best simulation models for training robotic surgery. However, high costs and ethical concerns limit their use and availability. In addition, simulated training in a specific context should demonstrate evidence of validity to be recommended.
Objective: To develop an ex vivo simulation model and validate its application in synthesis and hemostasis training in robotic surgery.
Methods: A simulation model for the training of synthesis and hemostasis in robotic surgery was built from human placentas. Then, a validation study was carried out using the Messick’s framework. Participants were classified as experts who had at least fifty robotic cases performed and trainees who were attending surgeons with simulation experience but no clinical experience in robotic surgery. A standardized explanation about a hemostatic suture exercise using the robotic platform to control a simulated bleeding was presented to the subjects and then administered a practice round in the simulation model. Each training was recorded and a blinded rater would then evaluate the performances using GEARS tool and checklist for suturing in robotic surgery. Then, we invited all participants to perform a suture exercise similar to the human placental model in virtual reality simulators and dry lab. The results were correlated with the suture exercise in ex vivo model. In the end, all participants received individual feedback and completed a questionnaire to assess the impact of the training, based on Kirkpatrick's model.
Results: In total, seven experts and eight trainees completed the training. All experts assessed ex vivo simulator as realistic and usefulness as a training tool and most participants considered ex vivo simulator more motivating to train robotic surgery than the others simulators. The assessments using objective evaluations tools allowed a clear discrimination between experts and trainees (p<0,005) and the results were consistent from one measurement to another (Cronbach’s Alpha Coefficient = 0.9275). There was a positive Pearson’s correlation between the performance scores of this ex vivo model and the other simulators (p<0,0001).
Conclusions: This preliminary study suggests that the human placenta simulation model is reliable in training fundamental surgical competencies in robotic surgery. Many sources of evidence had been demonstrated for the validation process in the application of this training model.

Palavras Chave ( separado por ; )

Robotic surgery; Simulation training; Models; Education; Clinical competence.