Charakterisierung von Lernkurven am Da Vinci Skills Simulator

The aim of this study was to evaluate the effect of training on the performance outcome with the da Vinci Skills Simulator by representing learning curves. Following the question of investigation of a structured training program for robotic surgical skills for robotic novices, this study focused on the da Vinci Skills Simulator known as an effective training tool for the acquisition of proficiency level. The present prospective study was conducted from January to December 2013 In the department of otorhinolaryngology, Philipps Universität Marburg and included 40 participants. Students and robotic novices were equally distributed into two groups for a fourweek training curriculum. By getting a short briefing in using the da Vinci Skills Simulator one group performed four training sessions on day 1, 8, 15 and 22 of three consecutive repetitions of five exercises (Match Board I, Match Board II, Match Board III, Ring & Rail I, Ring & Rail II) and a final unpracticed exercise (Needle Control). The second group started by receiving the same briefing on day 1 and finished on day 22 (without day 8 and 15) with the final exercise (Needle Control). After each completed repetition, data was analyzed for the parameters time to complete exercise, economy of motion, excessive instrument force, instruments out of view, collisions and drops summarized to a calculated overall score by the system. Furthermore, the participants in group one were additionally distributed into three groups depending on their day-overall score of each exercise in order to investigate their learning progress. The results showed a skills gain in overall performance on the first and second day in group one in nearly all parameters. Considering higher overall scores in group one due to a shorter rate of repetitions compared to group two, group one has been shown stagnation in Ring & Rail I and Match Board II in the parameters time to complete exercise, economy of motion, excessive instrument force and instruments out of view on day 2. Two days of training seem to be the best practice for exercises classified as very easy (Ring & Rail I) and easy (Match Board I) in this study. More repetitions in group one were needed for Match Board III and Ring & Rail II to reduce fatal errors such as collisions, excessive instrument force and instruments out of view by achieving overall scores >80%. Match Board II and Ring & Rail II, classified as exercises with a high difficulty level presented the strongest learning curves though showing the lowest parameters and overall scores. The rate of repetitions impairing the training of motorial skills, leads to internal learning curves and approximation of the test persons’ level. The level of difficulty was also reflected in the latency of approximation of the participants which could be seen as well in easy exercises (Ring & Rail I, Match Board I) on day 8, in medium (Match Board II) exercises on day 15 and in difficult exercises (Match Board III, Ring & Rail II) on day 22. Match board III and Ring & Rail II classified as difficult exercises presented the strongest learning curves although showing the nearly lowest parameters and overall score on the first day. Concerning exercises of a medium and high difficulty level, training experiences gained by performing each of the five exercises on one day, shorter training breaks of more than one but less than seven days and also unless seven repetitions of each exercise could be presumed. The parameter drop could be useful to measure the concentration of a test person. Group two as a control group came up with a lower increase of parameter levels and overall score outcome on day 2. There were significant differences in time to complete exercises, economy of motion and missed targets but no significant differences in overall score towards group one in the exercise Needle Control. Finally concluding the data of this study, it refers the da Vinci Skills Simulator led to an improvement in technical performance of robotic novices. This curriculum shows an important role relying more on repetitions than on long time distances in between the training sessions as an effective method for regaining fine motor skills in all exercise as well as for novice being skilled or less skilled in the first place.