Virtual Reality Training Improves da Vinci Performance: A Prospective Trial

Introduction: The DV-Trainer (TM) (a virtual reality [VR] simulator) (Mimic Technologies, Inc., Seattle, WA) is one of several different robotic surgical training methods. We designed a prospective study to determine whether VR training could improve da Vinci (R) Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) performance. Subjects and Methods: Surgeons (n = 12) were enrolled using a randomized protocol. Groups 1 (VR training) and 2 (control) participated in VR and da Vinci exercises. Participants' time and moving distance were combined to determine a composite score: VR index = 1000/(time u moving distance). The da Vinci exercises included needle control and suturing. Procedure time and error were measured. A composite index (DV index) was computed and used to measure da Vinci competency. After the initial trial with both the VR and da Vinci exercises, only Group 1 was trained with the VR simulator following our institutional curriculum for 3 weeks. All members of both groups then participated in the second trial of the VR and da Vinci exercises and were scored in the same way as in the initial trial. Results: In the initial trial, there was no difference in the VR index (Group 1 versus Group 2, 8.9 +/- 3.3 versus 9.4 +/- 3.7; P =.832) and the DV index (Group 1 versus Group 2, 3.85 +/- 0.73 versus 3.66 +/- 0.65; P =.584) scores between the two groups. At the second time point, Group 1 showed increased VR index scores in comparison with Group 2 (19.3 +/- 4.5 versus 9.7 +/- 4.1, respectively; P =.001) and improved da Vinci performance skills as measured by the DV index (5.80 +/- 1.13 versus 4.05 +/- 1.03, respectively; P =.028) and by suturing time (7.1 +/- 1.54 minutes versus 10.55 +/- 1.93 minutes, respectively; P =.018). Conclusions: We found that VR simulator training can improve da Vinci performance. VR practice can result in an early plateau in the learning curve for robotic practice under controlled circumstances.