Abstract:

Introduction:
Robot-assisted surgical procedures have gained widespread adoption in medical practice. The acquisition of equipment for performing robot-assisted operative interventions is becoming increasingly prevalent among centers in Bulgaria, which opens unique opportunities for novel treatment approaches of patients with cancer. The need for qualified specialists is therefore increased, and this may be achieved via virtual reality simulators. This study objectively evaluates the effectiveness of virtual reality simulators in the training of robotic surgery.

Materials and methods:
34 participants who voluntarily took part the on da Vinci Skills Simulator. Participants were 30 medical students between 3rd and 6th year of study, 2 surgical interns and 2 surgical specialists, who took part voluntarily, after being previously informed about the purpose of the study. They were trained in five sessions on five basic procedures of the simulator: 30-degree Scope Swap, Camera Targeting 1, Needle Targeting, Sea Spikes 1, Thread the Rings. The learning curves were monitored for four specific parameters: time taken to perform the procedure, visualization of the operative field, economy of movements, and the overall results of the procedures. SPSS is used to statistically process the results.

Results:
The average execution time of the five procedures for all participants is significantly reduced during individual sessions. For instance in the group of students, a double reduction of the time between the first and second attempt was observed. Further, the results pertaining to the visualization of the operative field indicate that learning the camera control technique proves challenging for the participants.
In respect to number of movements during the procedure, participants greatly reduced their movements. It was found that there is an increase and improvement in the average scores of the participants. The statistical analysis of the results showed improvement of the average performance achieved by the participants in the 5 exercises from the first trial to the fifth trial of each exercise.
The results of the Mann-Whitney test showed that in the exercises "Camera targeting 1," "Needle targeting," and "30-degree scope swap," men had higher mean scores compared to women, although the differences were not statistically significant. The only statistically significant gender-related finding was observed in the first two trials of the 'Thread the rings' exercise, where men outperformed women. This exercise proved to be the most challenging.
The results from the T-test showed that participants with prior experience in handling firearms exhibited superior performance in the 30-degree scope swap and Needle targeting exercises. Moreover, participants who routinely used a right-handed knife while eating demonstrated enhanced skills in the 30-degree scope swap exercise. In the "Thread the rings" exercise, participants who played musical instruments or engaged in sports achieved better outcomes. All of these findings were statistically significant, with t-test p-values below 0.05.

Conclusion:
The virtual reality simulation training for robotic surgery has extensive utility in the training of upcoming surgical specialists. Specific personal characteristics can be directly linked to the acquisition of new skills. The results obtained from this study will be effectively utilized to enhance simulator-based education initiatives.

Keywords:

Robotic surgery, virtual reality, virtual reality simulator, minimally invasive surgery, education with simulation, robot-assisted surgery.